dell'Agnola C A, Carmassi L M, Merlo D, Tadini B
Department of Pediatric Surgery, Postgraduate School, University of Milan, Italy.
Z Kinderchir. 1990 Oct;45(5):286-90. doi: 10.1055/s-2008-1042602.
A potential relationship between duration and severity of obstructive hydronephrosis and the histological structure of the upper urinary tract smooth musculature has been studied in a series of prenatally diagnosed cases. Between 1981 and 1988, fifty-five monolateral pyelo-ureteral junction obstructions (PUJO), prenatally diagnosed (16th-37th week of gestational age), underwent pyeloplasty between 4 and 90 days of life. Gestational age at the diagnosis, delta t (duration of hydronephrosis from first detection in utero to surgery) and V (volume of the hydronephrotic kidney) were related to the frequency of muscle hypotrophy and fibrosis of both pelvis and ureter just above and below the junction. A close correlation between duration (delta t) and the severity of the involvement of the smooth musculature of the upper urinary tract was found. The larger the volumes (V), the more severe the muscular damage. In the long-term follow-up, poor results were obtained only in 5 of the 19 newborn who had severe hypotrophy and fibrosis of the pelvis. In conclusion, in PUJO, the shorter the delta t and the lower the V, the better one expects the smooth musculature of the upper urinary tract to be.
在一系列产前诊断的病例中，研究了梗阻性肾积水的持续时间和严重程度与上尿路平滑肌组织结构之间的潜在关系。1981年至1988年间，55例产前诊断（孕龄16 - 37周）的单侧肾盂输尿管连接部梗阻（PUJO）患儿在出生后4至90天内接受了肾盂成形术。诊断时的孕龄、Δt（从子宫内首次发现肾积水到手术的持续时间）和V（肾积水肾脏的体积）与肾盂输尿管连接部上下方肾盂和输尿管肌肉萎缩及纤维化的发生率相关。发现持续时间（Δt）与上尿路平滑肌受累的严重程度密切相关。体积（V）越大，肌肉损伤越严重。在长期随访中，19例肾盂严重萎缩和纤维化的新生儿中只有5例效果不佳。总之，在PUJO中，Δt越短，V越低，上尿路平滑肌的状况预计越好。
