产前 1 级或 2 级肾积水行腹部超声检查和终止随访观察的适宜时机。
Appropriate timing of performing abdominal ultrasonography and termination of follow-up observation for antenatal grade 1 or 2 hydronephrosis.
机构信息
Education and Research Center for Community Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Urology, Gamagori City Hospital, Gamagori, Japan.
出版信息
BMC Urol. 2020 Nov 3;20(1):178. doi: 10.1186/s12894-020-00750-y.
BACKGROUND
Most cases of antenatal the Society of Fetal Urology (SFU) grade 1or 2 hydronephrosis (HN) improve or resolve spontaneously with conservative treatment. However, there is no consensus on the duration of follow-up for cases of grade 1or 2 HN. The aim of this study was to determine the need for continuous follow-up period and new management of children with antenatal grade 1or 2 HN.
METHODS
Subjects underwent ultrasonographic assessment for HN according to the SFU classification. We retrospectively evaluated 112 patients with postnatal grade 1 HN and 69 with grade 2 HN using abdominal ultrasonography between January 2010 and December 2017. We examined the change in HN grade on repeat ultrasonography. Kaplan-Meier method was used to show the effect of HN grade on the rate of HN changes.
RESULTS
The mean follow-up duration was 44.9 ± 36.4 months (range 12-274). Initial SFU grade 1 HN disappeared in 47.0% of cases at 12 months, 66.4% at 24 months and 73.2% at 48 months. Initial SFU grade 2 HN showed improvement in grade in 74.7% of cases at 12 months, 88.3% at 24 months and 89.5% at 48 months. However, 14.6% of SFU grade 1 and 2.8% of SFU grade 2 cases increased in grade and of the 17 cases, 16 cases worsened within the first 6 months. No cases with increased grade required pyeloplasty. Initial disappearance and later reappearance of HN occurred in 40.5% of SFU grade 1 and 2 cases. The mean duration of later reappearance of HN was 39.1 ± 36.2 months (range 12-137). No cases showed reappearance of HN after more than 1 year.
CONCLUSIONS
Ultrasonography within the first 6 months was necessary for management of children with antenatal grade 1or 2 HN, because some patients showed worsening. After that, it is considered safe to spread the follow-up interval for stable cases. Most cases of grade 1or 2 HN resolved spontaneously, however a few cases reappeared within 1 year. Therefore, ultrasonography after 1 year was necessary in children with HN that spontaneously disappeared. The appropriate time to end the follow-up was considered to have been after 1 year or more has passed since the disappearance was confirmed.
背景
大多数产前社会胎儿泌尿外科学会（SFU）1 级或 2 级肾积水（HN）病例通过保守治疗可自行改善或消退。然而，对于 1 级或 2 级 HN 病例的随访持续时间尚无共识。本研究旨在确定需要持续随访时间以及对产前 1 级或 2 级 HN 患儿的新治疗方法。
方法
根据 SFU 分级，对患儿进行超声评估 HN。我们回顾性评估了 2010 年 1 月至 2017 年 12 月期间 112 例产后 1 级 HN 和 69 例 2 级 HN 患儿的腹部超声检查结果。我们检查了重复超声检查 HN 分级的变化。Kaplan-Meier 法用于显示 HN 分级对 HN 变化率的影响。
结果
平均随访时间为 44.9±36.4 个月（范围 12-274）。12 个月时，47.0%的初始 SFU 1 级 HN 消失，24 个月时为 66.4%，48 个月时为 73.2%。初始 SFU 2 级 HN 在 12 个月时改善分级的比例为 74.7%，24 个月时为 88.3%，48 个月时为 89.5%。然而，14.6%的 SFU 1 级和 2.8%的 SFU 2 级病例分级增加，在 17 例中，16 例在最初 6 个月内恶化。没有分级增加的病例需要肾盂成形术。40.5%的 SFU 1 级和 2 级病例的 HN 最初消失后再次出现。HN 再次出现的平均持续时间为 39.1±36.2 个月（范围 12-137）。1 年以上无 HN 再次出现。
结论
产前 1 级或 2 级 HN 患儿需要在最初 6 个月内进行超声检查，因为部分患儿的病情出现恶化。之后，对于稳定的病例，延长随访间隔是安全的。大多数 1 级或 2 级 HN 病例可自发缓解，但少数病例在 1 年内再次出现。因此，对于 HN 自然消失的患儿，有必要在 1 年后进行超声检查。自消失确认后 1 年以上，认为是结束随访的适当时间。
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