胎儿肾积水的宫内治疗

doi:10.12280/gjfckx.20210988

摘要/Abstract

摘要：

目的: 探讨胎儿双侧肾积水在肾盂-羊膜腔分流术后的围生结局。方法: 回顾性分析2017年1月—2020年10月河南省人民医院产科经多学科会诊的双侧肾积水胎儿35例,按不同的治疗方法分组,其中宫内治疗组7例,于肾积水严重一侧给予肾盂-羊膜腔分流;另28例为保守治疗组,定期复查肾积水程度,分析宫内治疗组（肾盂-羊膜腔分流术后）肾积水缓解情况及羊水量,并比较2组的围生结局及新生儿生存率和手术率。结果: 分流术后胎儿肾积水缓解4例,占57.14%（4/7）,羊水量改善6例,占85.71%（6/7）,胎儿肾皮质受压有不同程度缓解。宫内治疗组新生儿的28 d生存率和手术率均高于保守治疗组（P<0.05）。2组的新生儿半年生存率和1年生存率差异无统计学意义（P>0.05）。结论: 肾盂-羊膜腔分流术减少了肾积水对胎儿肾实质的压迫,改善羊水量,能够提高新生儿28 d生存率。

关键词: 胎儿, 肾盂积水, 超声检查,产前, 存活率, 婴儿,新生

Abstract:

Objective: To evaluate the perinatal consequence after fetal pelvic-amniotic shunt for bilateral antenatal hydronephrosis. Methods: A retrospective analysis of 35 fetuses with bilateral hydronephrosis was made in the Obstetrics Department of Henan Provincial People′s Hospital from January 2017 to October 2020 through multidisciplinary consultation. 7 cases in the intrauterine treatment group were given pelvic-amniotic shunt on the severe side of hydronephrosis, and 28 cases who had regular reexamination of the degree of hydronephrosis were conservative group, to analyze the relief of hydronephrosis and amniotic fluid volume after shunting, and the perinatal outcome, neonatal survival rate and operation rate of the two groups were compared. Results: Fetal hydronephrosis was relieved after shunt in 4 cases, accounting for 57.14% (4/7), and amniotic fluid volume improved in 6 cases, accounting for 85.71% (6/7). The compression of hydronephrosis on the fetal kidney parenchyma had remitted in different degrees after vesicoamniotic shunting, the 28-day survival rate of newborns and the operation rate in the intrauterine treatment group were significantly higher than that of the conservative group(P<0.05). There was no significant difference in the half-year survival rate and 1-year survival rate of the two groups(P>0.05). Conclusions: Pelvic-amniotic shunt can reduce the compression of hydronephrosis on the fetal kidney parenchyma, improve amniotic fluid volume, and can improve the 28-day survival rate of newborns.

Key words: Fetus, Hydronephrosis, Ultrasonography,prenatal, Survival rate, Infant,newborn

武文娟, 刘侃, 王莉, 王睿丽, 武海英. 胎儿肾积水的宫内治疗[J]. 国际妇产科学杂志, 2022, 49(3): 350-353.

WU Wen-juan, LIU Kan, WANG Li, WANG Rui-li, WU Hai-ying. The Therapy of Antenatal Hydronephrosis[J]. Journal of International Obstetrics and Gynecology, 2022, 49(3): 350-353.

图/表 5

参考文献 13

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组别	n	年龄（岁）	孕周（周）
宫内治疗组	7	24.86±3.44	26.71±3.09
保守治疗组	28	28.46±4.78	27.04±5.03
t（P）		-1.870（0.070）	-0.153（0.879）

组别	n	年龄（岁）	孕周（周）
宫内治疗组	7	24.86±3.44	26.71±3.09
保守治疗组	28	28.46±4.78	27.04±5.03
t（P）		-1.870（0.070）	-0.153（0.879）

病例	治疗孕周	肾盂分离值（mm）		羊水指数		肾皮质厚度（mm）
病例	治疗孕周	术前	术后1个月	术前	术后1个月	术前	术后
1	27	22	15	46	96	2.10	2.40
2	30	36	34	120	146	1.80	2.35
3	26	26	30	58	76	1.40	2.00
4	22	35	35	62	90	2.50	2.60
5	30	24	20	78	87	2.70	2.90
6	25	27	25	80	92	3.50	3.60
7	23	34	34	65	55	1.70	1.90

病例	治疗孕周	肾盂分离值（mm）		羊水指数		肾皮质厚度（mm）
病例	治疗孕周	术前	术后1个月	术前	术后1个月	术前	术后
1	27	22	15	46	96	2.10	2.40
2	30	36	34	120	146	1.80	2.35
3	26	26	30	58	76	1.40	2.00
4	22	35	35	62	90	2.50	2.60
5	30	24	20	78	87	2.70	2.90
6	25	27	25	80	92	3.50	3.60
7	23	34	34	65	55	1.70	1.90

病例	分娩孕周	新生儿体质量（g）	Apgar评分<4分		新生儿死亡	儿科住院时间（d）	机械通气	术式
病例	分娩孕周	新生儿体质量（g）	1 min	5 min	新生儿死亡	儿科住院时间（d）	机械通气	术式
1	37	2 570	否	否	否	0	否	肾盂输尿管成形
2	39	3 300	否	否	否	0	否	肾盂输尿管成形
3	30	1 710	是	是	是	14	是	-
4	33	2 050	否	否	否	10	否	肾切除
5	38	3 520	否	否	否	0	否	肾盂输尿管成形
6	38	3 300	否	否	否	0	否	输尿管再植
7	31	1 800	否	否	是	21	是	-