Reis Leonardo Oliveira, Ikari Osamu, Zani Emerson Luís, Moretti Tomás Bernardo Costa, Gugliotta Antonio
Department of Urology, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
Eur J Pediatr Surg. 2015 Dec;25(6):509-12. doi: 10.1055/s-0034-1390018. Epub 2014 Oct 4.
After a successful pyeloplasty at 3 to 6 months, the question remains whether children need a long follow-up.
The medical charts of patients with long-term follow-up (> 5 years), who underwent dismembered pyeloplasty for uretero-pelvic junction obstruction (UPJO) from May 1998 to May 2007, excluding those with bilateral UPJO, solitary kidney, associated vesicoureteral reflux or other abnormalities, and inconclusive renogram due to poor renal function, were retrospectively reviewed. Ultrasonography, differential renal function (DRF, DMSA), and renal drainage on diuretic renography (diethylene-triamine-pentaacetate technetium-99 or DTPA-Tc99) were performed at 3 and 6 months every year.
Complete data were available for 28 consecutive patients (28 renal unities) with 2 months to 12 years (mean age, 2.4 years) at surgery, of whom 21 (75%) were boys, 17 diagnosed prenatally (61%) and 18 unities (64.3%) were left, with median follow-up of 10.7 years. Images were graded according to the Society for Fetal Urology grading system: Grade III in 11 (49%) and grade IV in 17 (61%). All cases presented > 10% DRF (DMSA) and obstructed DTPA-Tc99. The T1/2 (the half-time of drainage) less than 20 minutes at 3 months was found in 21 cases (75%) and less than 25 minutes in 7 cases (25%). Renal function and patency were maintained during follow-up for all units with 8% maximum fluctuation of DRF. One index case (3.6%) of renal function deterioration presented DRF fluctuation > 8% at 3 months (from 23 to 32%) and progressive hydronephrosis and indeterminate DTPA at 6 months.
Satisfactory diuretic renogram at 3 to 6 months after pyeloplasty with maintained renal function and stable hydronephrosis suggests no need for further follow-up and indicates no functional loss with time. More than 8% DRF fluctuation might be a significant cutoff for further intervention aiming nephron preservation.
在肾盂成形术成功实施3至6个月后，儿童是否需要长期随访仍是个问题。
回顾性分析1998年5月至2007年5月期间因肾盂输尿管连接部梗阻（UPJO）接受离断性肾盂成形术且进行长期随访（>5年）患者的病历，排除双侧UPJO、单肾、合并膀胱输尿管反流或其他异常以及因肾功能差导致肾图结果不明确的患者。每年在3个月和6个月时进行超声检查、分肾功能（DRF，二巯基丁二酸）以及利尿肾图（二乙烯三胺五乙酸锝-99或DTPA-Tc99）评估肾脏引流情况。
连续28例患者（28个肾脏单位）有完整数据，手术时年龄为2个月至12岁（平均年龄2.4岁），其中21例（75%）为男孩，17例（61%）产前诊断，18个单位（64.3%）为左侧，中位随访时间为10.7年。图像根据胎儿泌尿外科学会分级系统进行分级：III级11例（49%），IV级17例（61%）。所有病例的DRF（DMSA）均>10%且DTPA-Tc99显示梗阻。3个月时T1/2（引流半衰期）小于20分钟的有21例（75%），小于25分钟的有7例（25%）。随访期间所有单位的肾功能和通畅情况均得以维持，DRF最大波动为8%。1例（3.6%）肾功能恶化的指标病例在3个月时DRF波动>8%（从23%至32%），6个月时出现进行性肾积水且DTPA结果不确定。
肾盂成形术后3至6个月利尿肾图结果满意、肾功能维持且肾积水稳定表明无需进一步随访，且未随时间出现功能丧失。DRF波动超过8%可能是旨在保留肾单位的进一步干预的重要临界值。
