Salem Y H, Majd M, Rushton H G, Belman A B
Department of Pediatric Urology, Children's National Medical Center, George Washington University Medical Center, Washington, D.C., USA.
J Urol. 1995 Nov;154(5):1889-93.
We retrospectively reviewed a consecutive series of patients who underwent pyeloplasty. In all cases preoperative and postoperative isotope renal scans were performed to assess the surgical outcome with particular emphasis on the change in renal function postoperatively.
The clinical records of 108 consecutive children with ureteropelvic junction obstruction were reviewed. Individual renal function was evaluated and obstruction was confirmed by diuretic assisted 99mtechnetium diethylenetriaminepentaacetic acid or mercaptoacetyltriglycine renography. A total of 100 pyeloplasties in 98 children between 5 days and 16 years old was included. Results were analyzed by groups according to patient age and symptoms at presentation.
Drainage half-times improved in 98% of patients and only 1 required reoperation. Improved renal function greater than 5% was noted in about a third of each age group. Function remained stable in 68% of the kidneys and decreased in only 1. Of the improved kidneys 77% had impaired function preoperatively (40% or less of the total contribution). Those presenting with a renal mass had the greatest improvement in function. There was no statistically significant difference in improvement in renal function by age group or patient presentation. Regression analysis revealed that preoperative differential renal function was the only statistically significant predictor of improvement in renal function after pyeloplasty.
Pyeloplasty in children is safe and renal functional improvement can be expected in the majority of kidneys with impaired function at presentation. However, there was no indication that early pyeloplasty in infants is more likely to result in improved function than in older children.
我们回顾性分析了一系列连续接受肾盂成形术的患者。所有病例均在术前和术后进行同位素肾扫描，以评估手术效果，尤其着重于术后肾功能的变化。
回顾了108例连续的输尿管肾盂连接部梗阻患儿的临床记录。通过利尿辅助的锝-二乙三胺五乙酸或巯基乙酰三甘氨酸肾图评估个体肾功能，并确认梗阻情况。纳入了98例年龄在5天至16岁之间的患儿共100次肾盂成形术。根据患者年龄和就诊时的症状对结果进行分组分析。
98%的患者引流半衰期得到改善，仅1例需要再次手术。每个年龄组中约三分之一的患者肾功能改善超过5%。68%的肾脏功能保持稳定，仅1例肾功能下降。在肾功能改善的肾脏中，77%术前功能受损（占总功能的40%或更少）。表现为肾肿块的患者功能改善最大。按年龄组或患者表现划分，肾功能改善情况无统计学显著差异。回归分析显示，术前分肾功能是肾盂成形术后肾功能改善的唯一具有统计学意义的预测指标。
儿童肾盂成形术是安全的，大多数就诊时功能受损的肾脏有望实现肾功能改善。然而，没有迹象表明婴儿早期进行肾盂成形术比大龄儿童更有可能改善功能。
