本文選題：兒童 + 腎積水　； 參考：《復(fù)旦大學(xué)》2014年碩士論文

【摘要】：研究目的：目前,現(xiàn)有的研究文獻(xiàn)對于小兒腎盂輸尿管交界處梗阻(UPJO)離斷式腎盂成形術(shù)后,患腎的分腎功能是否恢復(fù)以及哪些因素影響術(shù)后分腎功能的提高仍然存在很大的爭議。本研究的主要目的是通過對比研究UPJO患兒手術(shù)前、后分腎功能的變化,以了解患腎分腎功能是否得到提高,并探討術(shù)前各種因素對腎積水術(shù)后分腎功能恢復(fù)的影響。資料與方法：回顧性分析了2008年3月至2012年8月期間本院泌尿外科手術(shù)的單側(cè)UPJO腎積水患兒,排除孤立腎、雙側(cè)腎積水及合并有其它泌尿系統(tǒng)畸形、疾病的病例,所有納入本研究的患兒均在手術(shù)前做過泌尿系統(tǒng)超聲檢查及利尿性腎動態(tài)顯像,并且在手術(shù)后至少隨訪過一次利尿性腎動態(tài)顯像。分析手術(shù)前、后分腎功能的變化,并以術(shù)后分腎功能增加大于等于5%作為分腎功能好轉(zhuǎn)的參考標(biāo)準(zhǔn)。將手術(shù)前患兒性別、月齡分組、積水的左右側(cè)、積水腎的SFU分級及分腎功能(DRF)分級、利尿性腎圖曲線類型作為潛在的影響因素,與術(shù)后分腎功能是否改善作二分類的Logistic回歸分析。所有統(tǒng)計分析均采用IBM SPSS v21統(tǒng)計軟件進(jìn)行處理,以P0.05作為具有統(tǒng)計學(xué)意義的標(biāo)準(zhǔn)。結(jié)果：共有213例患兒納入本研究,其中男181例,女32例,術(shù)前患兒年齡為1周-148月,平均34.5月。手術(shù)后隨訪DRF由術(shù)前32.61%±14.09%增加到40.43%±11.32%,經(jīng)兩樣本配對t檢驗得到p0.05(p=0.000),即術(shù)后首次隨訪分腎功能的變化有統(tǒng)計學(xué)意義。以5%變化來判斷,僅1例術(shù)后分腎功能惡化,102例腎功能穩(wěn)定,110例腎功能有恢復(fù)。術(shù)前患兒性別、年齡、積水側(cè)、積水的SFU分級、術(shù)前DRF分級以及術(shù)前腎圖曲線類型作為潛在的影響因素,與術(shù)后腎功能是否改善作二項Logistic回歸分析,提示術(shù)前的分腎功能、腎積水的程度以及手術(shù)時的年齡都是影響術(shù)后分腎功能恢復(fù)的影響因素,而性別、積水的左右側(cè)、術(shù)前患腎腎圖曲線類型則不是。術(shù)后分腎功能并不隨時間的延長而持續(xù)增長。結(jié)論：小兒腎積水手術(shù)解除梗阻后,患腎的積水程度和排泄?fàn)顩r都能得到改善,并且積水腎的分腎功能是可以得到提高的,術(shù)前的分腎功能、腎積水的程度以及手術(shù)時的年齡都是影響術(shù)后分腎功能恢復(fù)的影響因素,而術(shù)后腎功能的改變與患者的性別、積水的左右側(cè)、術(shù)前腎臟的排泄梗阻狀況以及隨訪時間無關(guān)。研究目的：目前,對小兒腎積水術(shù)前分腎功能低于10%的患腎是否行腎切除術(shù)存在較大的爭議。本研究的主要目的是探討能否以術(shù)前分腎功能小于10%作為腎切除術(shù)的指征。并進(jìn)一步探討若以術(shù)前分腎功能作為參考,重度UPJO腎積水腎切除的指征。資料與方法：回顧性分析了2008年3月至2012年8月期間本院泌尿外科手術(shù)的單側(cè)UPJO腎積水患兒,納入標(biāo)準(zhǔn)同本研究第一部分,且要求術(shù)前分腎功能低于40%。根據(jù)術(shù)前DRF,分為3組,即Ⅰ組：10%≤術(shù)前DRF40%,Ⅱ組：5%≤術(shù)前DRF10%,Ⅲ:術(shù)前DRF5%。分析各組手術(shù)前后分腎功能的變化,并以增加5%作為分腎功能好轉(zhuǎn)的標(biāo)準(zhǔn)。采用配對樣本t檢驗,統(tǒng)計分析采用IBM SPSS v21軟件進(jìn)行,以p0.05作為具有統(tǒng)計學(xué)意義。結(jié)果：共有128例患兒進(jìn)入本研究,其中男108例,女20例。Ⅰ組、Ⅱ組患兒術(shù)后DRF分別由27.50%±7.44%、8.58%±1.38%提高到39.28%±8.34%、26.73%±11.97%,手術(shù)前后變化值均有統(tǒng)計學(xué)意義(p=0.000),表明腎盂成形術(shù)后患腎分腎功能得到明顯提高。而Ⅲ組患兒術(shù)后DRF由3.89%±0.88%變?yōu)?.63%±0.94%,手術(shù)前后變化值無統(tǒng)計學(xué)意義(p=0.602),表明術(shù)后分腎功能沒有提高。結(jié)論：分腎功能小于10%不能作為小兒腎積水腎切除術(shù)的指征,這部分患兒行腎盂成形術(shù)后患腎功能有得到提高甚至恢復(fù)正常的可能。但若以5%為標(biāo)準(zhǔn),腎盂成形術(shù)后患腎功能未見提高,可以考慮以分腎功能低于5%作為腎切除術(shù)的參考標(biāo)準(zhǔn)。
[Abstract]:Research purposes: Currently, there is still a lot of controversy in the current research literature on whether the renal function recovery of the kidney is restored and what factors affect the improvement of renal function after the ureteropelvoplasty (UPJO) in children with ureteropelvic junction obstruction (UPJO). The main purpose of this study is to compare the pre operation and post operation of UPJO children. Changes in the function of the kidney in order to know whether the renal function has been improved or not, and the effect of various factors on the recovery of renal function after hydronephrosis. Data and methods: a retrospective analysis of the unilateral UPJO nephrectomy in the Department of urology from March 2008 to August 2012, the exclusion of isolated kidney, bilateral hydronephrosis and combined treatment, was reviewed. All the cases with other urinary tract malformations and diseases were examined by ultrasound and diuretic dynamic imaging before the operation, and at least one diuretic renal dynamic imaging was followed up at least once after the operation. The changes of renal function before operation were analyzed, and the increase of renal function after operation was equal to 5%. As a reference standard for the improvement of renal function, the sex, the age group, the left and right side of the hydronephrosis, the SFU classification of the hydronephrosis and the classification of the renal function (DRF), the type of diuretic renogram as the potential influencing factor and the two classification of the renal function after the operation were analyzed by Logistic regression analysis. All the statistical analysis used IBM SPSS v21 statistical software was treated with P0.05 as a standard of statistical significance. Results: a total of 213 children were included in this study, including 181 males and 32 females. The age of the pre operation children was 1 weeks -148 months, with an average of 34.5 months. The follow-up DRF was increased to 40.43% + 11.32%, and P0.05 (p=0) was obtained by a two sample paired t test. .000), that is, the changes of renal function after the first follow-up were statistically significant. Judging by 5% changes, only 1 cases were divided into renal function deterioration, 102 cases of renal function stability, 110 cases of renal function recovery. The preoperative sex, age, water side, water accumulation, SFU classification, preoperative DRF classification, and preoperative renal mapping curve type as potential influencing factors, Two Logistic regression analysis was made for the improvement of renal function after operation. It was suggested that the function of the kidneys, the degree of hydronephrosis and the age of the operation were the factors affecting the recovery of the renal function, while the sex, the left and right side of the hydrops, and the type of kidney and kidney graph curve before the operation were not. Conclusion: after the removal of obstruction in children with hydronephrosis, the degree of water accumulation and excretion of the kidney can be improved, and the renal function of the hydronephrosis can be improved. The function of the kidney, the degree of hydronephrosis and the age of the operation are the factors affecting the recovery of the renal function after operation, and the renal function after the operation. The changes are not related to the sex of the patient, the left and right side of the hydrops, the condition of the renal excretion obstruction and the time of follow-up. The purpose of this study is to discuss whether the kidney function is less than 10% of the kidney function before the operation of the nephrectomy. The main purpose of this study is to explore whether the renal function is less than 10% before operation. The indications of nephrectomy. And further discuss the indications of severe UPJO nephrectomy for renal hydronephrosis as a reference. Data and methods: a retrospective analysis of the unilateral UPJO hydronephrosis in the Department of Urology during the period from March 2008 to August 2012 was included in the first part of the same study, and the renal function was required before the operation. Lower than 40%. according to preoperative DRF, divided into 3 groups, i. e. group I: 10% less than DRF40% before operation, group II: 5% < DRF10% before operation, III: before and after operation DRF5%. analysis of renal function changes before and after operation, and increase 5% as the standard of renal function improvement. Using paired sample t test, statistical analysis using IBM SPSS v21 software, P0.05 as a system Results: a total of 128 children were enrolled in this study, including 108 males and 20 females. Group I, the postoperative DRF in group II was 27.50% + 7.44%, 8.58% + 1.38% to 39.28% + 8.34%, 26.73% + 11.97%, and the changes were statistically significant before and after operation (p=0.000). The renal function of renal pelvis after pyeloplasty was obviously improved. In group III, the postoperative DRF changed from 3.89% + 0.88% to 3.63% + 0.94%, and there was no statistical significance before and after operation (p=0.602), indicating that the function of renal function was not improved after operation. Conclusion: the function of renal function less than 10% can not be used as the indication of nephrectomy in children with hydronephrosis, and the renal function of the children after pyeloplasty is improved or even restored. It is often possible. However, if the standard of renal function is not improved after 5% cases of pyeloplasty, the renal function below 5% should be considered as a reference standard for nephrectomy.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R726.9

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本文編號：1967234