Li Xiao-Dong, Wu Yu-Peng, Wei Yong, Chen Shao-Hao, Zheng Qing-Shui, Cai Hai, Xue Xue-Yi, Xu Ning
Urol Int. 2018;100(2):209-215. doi: 10.1159/000486425. Epub 2018 Jan 18.
This study aimed to identify factors predicting the recoverability of renal function after pyeloplasty in adult patients with ureteropelvic junction obstruction.
We retrospectively reviewed 138 adults with unilateral renal obstruction-induced hydronephrosis and who underwent Anderson-Hynes dismembered pyeloplasty from January 2013 to January 2016. Hydronephrosis was classified preoperatively according to the Society for Fetal Urology (SFU) grading system. All patients underwent Doppler ultrasonography, excretory urography, computed tomography, and technetium-99m-diethylenetriamine pentaacetic acid radioisotope (99mTc DTPA) renography before and after surgery. Renal resistive index (RRI) and 99mTc DTPA renography were repeated at 1, 3, 6, and 12 months.
Multivariate analysis identified age, renal pelvic type, SFU grade, preoperative RRI, decline of RRI, and renal parenchyma to hydronephrosis area ratio (PHAR) as independent predictors of renal function recoverability after pyeloplasty. However, preoperative RRI and RRI decline were not significantly associated with recoverability of renal function in patients aged >35 years. Lower preoperative RRI, greater decline in RRI, higher PHAR, lower SFU grade, and extrarenal pelvis were associated with greater improvements in postoperative renal function.
Preoperative differential renal function cannot independently predict the recoverability of postoperative renal function in adult patients with unilateral renal obstruction-induced hydronephrosis. SFU grade, renal pelvic type, PHAR, preoperative RRI, and decline in RRI were significantly associated with the recoverability of renal function in adult patients aged <35 years, while only SFU grade, renal pelvic type, and PHAR were significantly associated with renal function recoverability in patients aged ≥35 years. Renal function recovery was better in patients younger than 35 years when compared with older patients.
本研究旨在确定预测成人输尿管肾盂连接部梗阻患者肾盂成形术后肾功能恢复情况的因素。
我们回顾性分析了2013年1月至2016年1月期间138例因单侧肾梗阻导致肾积水并接受安德森-海因斯离断性肾盂成形术的成人患者。术前根据胎儿泌尿学会（SFU）分级系统对肾积水进行分类。所有患者在手术前后均接受了多普勒超声、排泄性尿路造影、计算机断层扫描和锝-99m-二乙三胺五乙酸放射性核素（99mTc DTPA）肾图检查。在术后1、3、6和12个月重复测量肾阻力指数（RRI）和99mTc DTPA肾图。
多因素分析确定年龄、肾盂类型、SFU分级、术前RRI、RRI下降幅度以及肾实质与肾积水面积比（PHAR）为肾盂成形术后肾功能恢复的独立预测因素。然而，术前RRI和RRI下降幅度与年龄>35岁患者的肾功能恢复无显著相关性。术前RRI较低、RRI下降幅度较大、PHAR较高、SFU分级较低以及肾盂外肾盂与术后肾功能改善程度较大相关。
术前患侧肾功能不能独立预测单侧肾梗阻导致肾积水的成人患者术后肾功能的恢复情况。SFU分级、肾盂类型、PHAR、术前RRI以及RRI下降幅度与年龄<35岁成人患者的肾功能恢复显著相关，而对于年龄≥35岁的患者，只有SFU分级、肾盂类型和PHAR与肾功能恢复显著相关。与老年患者相比，35岁以下患者的肾功能恢复情况更好。
