Jain Vishesh, Kumar Rakesh, Arora Saurabh, Mani Kalaivani, Agarwala Sandeep, Yadav Devendra K, Goel Prabudh, Dhua Anjan
Department of Pediatric Surgey, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Department of Nulcear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
J Pediatr Urol. 2020 Jun;16(3):330.e1-330.e6. doi: 10.1016/j.jpurol.2020.02.008. Epub 2020 Feb 19.
Delayed cortical transit time (CTT) has been recently studied and proposed as a parameter that can predict the need for surgery in children with pelviureteric junction obstruction (PUJO).
The aim of this study was to study the change in CTT, after surgery, in children with PUJO and to correlate CTT with intrapelvic pressure of the kidney.
A prospective study was performed, and all children who underwent pyeloplasty from January 2016 to December 2017 were included. Pre-operative and postoperative renal ultrasonography and Technetium-99m mercaptoacetyltriglycerine Tc-MAG3 renal scintigraphy were performed. Cortical transit time was measured by a visual method by two different observers. The renal intrapelvic pressure of the kidney was also measured during surgery after giving a diuretic to replicate the diuresis induced during the renal scan. The correlation was studied between the pre-operative CTT and intrapelvic pressures and between the pre-operative CTT and the renal function of the affected kidney.
Thirty-one children were included in the study. The median age of children who underwent surgery was 50 months (2-168). In 71% of patients, the CTT was prolonged before surgery, whereas only 22.5% had delayed CTT after surgery. The mean CTT before surgery was 226.1 ± 74.8 s and decreased to 165.4 ± 55.9 s after surgery (p= <0.001). The mean intrapelvic pressure was 21 ± 7.5 cm HO. There was no correlation noted between the intrapelvic pressure and the CTT. A significant negative correlation was noted between the CTT and the different renal function of the kidney.
This is the first prospective study that studies the changes in CTT after surgery. Only retrospective studies had been conducted to date which concluded that CTT was delayed in most of the patients who had been operated. It has been proposed that the prolonged CTT is due to raised pressure in the kidney secondary to obstruction. This study did not find any correlation between the pressure and CTT. The significant negative correlation between CTT and renal function also emphasizes the need to take the renal function into consideration before interpreting and using the absolute value of CTT for guiding treatment.
Cortical transit time assessment by the visual method is a useful parameter in the management of children with PUJO. There is a significant improvement in CTT after surgery.
延迟皮质通过时间（CTT）最近已被研究，并被提议作为预测肾盂输尿管连接部梗阻（PUJO）患儿手术需求的一个参数。
本研究的目的是研究PUJO患儿手术后CTT的变化，并将CTT与患肾肾盂内压力进行关联。
进行了一项前瞻性研究，纳入了2016年1月至2017年12月期间所有接受肾盂成形术的患儿。术前行肾脏超声检查及99m锝-巯基乙酰三甘氨酸（Tc-MAG3）肾动态显像。由两名不同的观察者采用视觉方法测量皮质通过时间。在给予利尿剂以模拟肾动态显像时诱导的利尿后，术中也测量了患肾的肾盂内压力。研究了术前CTT与肾盂内压力之间以及术前CTT与患肾功能之间的相关性。
31名患儿纳入本研究。接受手术患儿的中位年龄为50个月（2 - 168个月）。71%的患者术前CTT延长，而术后只有22.5%的患者CTT延迟。术前平均CTT为226.1±74.8秒，术后降至165.4±55.9秒（p = <0.001）。平均肾盂内压力为21±7.5厘米水柱。未发现肾盂内压力与CTT之间存在相关性。CTT与患肾不同肾功能之间存在显著负相关。
这是第一项研究手术后CTT变化的前瞻性研究。迄今为止仅进行了回顾性研究，这些研究得出结论，大多数接受手术的患者CTT延迟。有人提出，CTT延长是由于梗阻继发的肾内压力升高所致。本研究未发现压力与CTT之间存在任何相关性。CTT与肾功能之间的显著负相关也强调了在解释和使用CTT绝对值指导治疗之前考虑肾功能的必要性。
采用视觉方法评估皮质通过时间是管理PUJO患儿的一个有用参数。手术后CTT有显著改善。
