發(fā)布時間：2018-07-11 12:31

  本文選題：胎兒 + 腎盂擴張　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:通過產(chǎn)前超聲診斷、檢測、分析孕晚期胎兒重度腎盂擴張的相關(guān)指標(biāo),以評價患兒的預(yù)后及轉(zhuǎn)歸情況。方法:本臨床研究選擇2015年12月至2016年12月于本院就診進行產(chǎn)前超聲檢查發(fā)現(xiàn)胎兒孕晚期患有重度腎盂擴張的孕婦30例(39只患腎),其中患有單側(cè)重度腎盂擴張的胎兒21例,雙側(cè)重度腎盂擴張的胎兒9例。本臨床研究將胎兒的腎盂前后徑分離程度(Anteroposterior diameter,APD)、腎實質(zhì)厚度(renal parenchymathickness,RPT)、腎動脈阻力指數(shù)(resistance index,RI)、腎動脈搏動指數(shù)(Pulsation index,PI)、腎動脈的收縮期峰值流速(PSV)/舒張末期流速(EDV)比值(S/D)及新生兒的腎功能(renal function,RF)等因素作為檢查指標(biāo),對這部分胎兒出生后的轉(zhuǎn)歸情況進行隨訪研究分析。要求對所選擇的全部病例在產(chǎn)前首次確診為重度腎盂擴張后2周、1個月、6個月及產(chǎn)前和分娩后5-7天進行多普勒超聲復(fù)查,對出生后仍患有腎盂擴張的患兒每隔3個月隨訪一次,并復(fù)查彩色多普勒超聲、泌尿系統(tǒng)造影或MRI及腎功能檢查,分別記錄APD、RPT、腎動脈RI、腎動脈PI及腎動脈S/D比值的變化情況,定期檢測患兒的腎功能,最長隨訪時間為1年。結(jié)果:(1)在30例孕晚期患有重度腎盂擴張的胎兒中有25例活產(chǎn)新生兒和5例引產(chǎn)胎兒;其中,在25例活產(chǎn)新生兒中有8例患兒隨訪至產(chǎn)后1年時復(fù)查超聲發(fā)現(xiàn)腎盂擴張明顯減輕或未見明顯變化,均采取保守治療;有3例患兒隨訪至產(chǎn)后1年時復(fù)查超聲發(fā)現(xiàn)腎盂擴張消失;有14例患兒隨訪至產(chǎn)后1年時復(fù)查超聲發(fā)現(xiàn)腎盂擴張呈進行性加重,均行手術(shù)治療。余5例均在產(chǎn)前行引產(chǎn)術(shù)終止妊娠,在引產(chǎn)的病例中僅1例引產(chǎn)前進行了羊水染色體核型的分析,結(jié)果證實為18-三體綜合征。(2)將孕晚期患有重度腎盂擴張的25例活產(chǎn)新生兒按照其出生后的預(yù)后轉(zhuǎn)歸情況分為III組:I組:產(chǎn)后腎盂擴張消失組,II組:產(chǎn)后腎盂擴張減輕或無變化組;III組:產(chǎn)后腎盂擴張加重組。隨訪結(jié)果表明:各組之間的妊娠結(jié)局及腎動脈RI值隨訪的結(jié)果存在顯著性差異,具有統(tǒng)計學(xué)意義(F_(腎動脈RI)=13.14,P0.05);結(jié)果顯示隨著胎兒腎盂擴張嚴(yán)重程度的進行性增加,其相應(yīng)的腎動脈RI也會增加。而各組之間的妊娠結(jié)局與腎動脈PI值及腎動脈S/D比值隨訪結(jié)果的比較均無統(tǒng)計學(xué)意義(F腎動脈PI=0.3012,F腎動脈S/D比值=0.3073,P均0.05)。各組之間的妊娠結(jié)局與APD、RPT的隨訪結(jié)果比較均具有顯著性差異,均具有統(tǒng)計學(xué)意義(FAPD=0.3012,FRPT=0.743,P均0.05)。結(jié)果顯示隨著胎兒腎盂擴張嚴(yán)重程度的進行性加重,其出生后的預(yù)后情況就會越差。研究發(fā)現(xiàn)孕晚期重度腎盂擴張?zhí)旱腁PD的平均范圍約2.42cm;RPT的平均厚度約0.27cm;腎動脈RI的平均范圍約0.85。(3)本研究將胎兒產(chǎn)后腎盂擴張減輕或無變化組與產(chǎn)后腎盂擴張加重組進行腎動脈RI值與APD之間的相關(guān)性分析,發(fā)現(xiàn)其相關(guān)值r=0.4898,P0.05,兩組差異有統(tǒng)計學(xué)意義,兩者存在低度正相關(guān)性。(4)本研究發(fā)現(xiàn)孕晚期患有單側(cè)與雙側(cè)重度腎盂擴張的胎兒在妊娠結(jié)局方面的比較,差異具有統(tǒng)計學(xué)意義(χ2=19.96,P0.05)。本研究發(fā)現(xiàn)不同性別的孕晚期重度腎盂擴張?zhí)涸谌焉锝Y(jié)局方面的比較,差異無統(tǒng)計學(xué)意義(χ2=0.21,P0.05)。結(jié)論:(1)孕晚期患有重度腎盂擴張?zhí)旱念A(yù)后與APD、RPT、腎動脈RI大小以及是否雙側(cè)均合并腎盂擴張等有一定的關(guān)系。(2)對于孕晚期APD2.42cm、RPT0.27cm、腎動脈RI值0.85的胎兒,在臨床上應(yīng)重點加強對其的產(chǎn)前超聲診斷和監(jiān)測,必要時選擇合適的孕周盡早終止妊娠。(3)在產(chǎn)后隨訪觀察的過程中若發(fā)現(xiàn)胎兒的腎盂擴張未見明顯緩解或呈進行性加重趨勢時,應(yīng)高度懷疑尿路系統(tǒng)是否存在梗阻性的病變,警惕患兒的腎功是否受損,因為孕晚期患有重度腎盂擴張的胎兒大部分具有病理性梗阻性的積水癥狀,需盡早進行手術(shù)治療才能緩解或消退。
[Abstract]:Objective: To evaluate the prognosis and prognosis of severe renal pelvis dilatation in the late pregnancy by prenatal ultrasound diagnosis, to evaluate the prognosis and prognosis of the children. Methods: 30 cases of pregnant women with severe renal pelvis dilatation in the late fetal pregnancy (39 patients with renal pelvis) were selected from December 2015 to December 2016 in our hospital. Among them, 21 cases with unilateral severe pyelonephrosis and 9 cases of bilateral severe pyelonephrosis, 9 cases of fetal renal pelvis separation (Anteroposterior diameter, APD), renal parenchyma thickness (renal parenchymathickness, RPT), renal artery resistance index (resistance index, RI), renal artery pulsation index (Pulsation I). Ndex, PI), the renal artery systolic peak velocity (PSV) / end diastolic flow rate (EDV) ratio (S/D) and neonatal renal function (renal function, RF) as a test index, follow up and study the outcome of this part of the fetus after birth. The first diagnosis of all cases in the prenatal period is 2 after the severe renal pelvis dilation. Weeks, 1 months, 6 months, and 5-7 days after birth and 5-7 days after birth, Doppler ultrasonography was conducted to follow up every 3 months for children who were still suffering from pyelonephrosis, and rechecked color Doppler ultrasound, urology or MRI and renal function examination. The changes of APD, RPT, renal artery RI, renal artery PI and the S/D ratio of renal artery were determined respectively. The longest follow-up time was 1 years. Results: (1) in 30 cases with severe renal pelvis dilatation in 30 cases, there were 25 live births and 5 induced aborted fetus. Among them, 8 of the 25 live births were followed up to 1 years postpartum. Conservative treatment was taken; 3 cases were followed up to 1 years postpartum, and the renal pelvis dilatation was found to disappear. 14 cases were followed up to 1 years postpartum to find that the renal pelvis dilatation was progressively aggravated. All the 5 cases were induced by induction of labor before birth. Only 1 cases in the cases of induced labor had amniotic fluid chromosomes before induction of labor. Karyotype analysis proved to be 18- trisomy syndrome. (2) 25 newborns with severe renal pelvis dilatation in the late pregnancy were divided into group III according to the prognosis of their postnatal prognosis: group I: postpartum pyelonephrosis disappearance group, group II: postpartum pyelonephrosis relieving or non change group; III group: postpartum pyelonephrosis and reconstitution. Follow up results showed: There were significant differences in the outcome of pregnancy and RI value of renal artery between each group, which was statistically significant (F_ (renal artery RI) =13.14, P0.05). The results showed that the corresponding renal artery RI increased with the progressive increase of fetal renal pelvis dilatation, and the pregnancy outcome and PI value of renal artery and renal artery S/D between each group. The results of ratio follow-up were not statistically significant (F renal artery PI=0.3012, F renal artery S/D ratio =0.3073, P 0.05). The pregnancy outcomes in each group were significantly different from those of APD, RPT, all with statistical significance (FAPD=0.3012, FRPT=0.743, P, 0.05). The results showed the severity of fetal renal pelvis dilation. Progressively worse, the worse the prognosis after birth. The study found that the average range of APD in the late trimester severe pyelonephrosis fetus was about 2.42cm, the average thickness of RPT was about 0.27cm, and the average range of RI of renal artery was about 0.85. (3). The correlation analysis between RI and APD found that the correlation value r=0.4898, P0.05, two groups were statistically significant, and there was a low positive correlation between the two. (4) this study found that the difference in pregnancy outcome of the fetus with unilateral and bilateral severe renal pelvis dilatation in the late pregnancy was statistically significant (x 2=19.96, P0.05). The findings of this study were found. There was no significant difference in pregnancy outcome between different sexes in the late pregnancy with severe pyelonephrosis fetus (x 2=0.21, P0.05). Conclusion: (1) the prognosis of severe renal pelvis dilatation in the late pregnancy was related to APD, RPT, the size of renal artery RI and bilateral dilatation of renal pelvis. (2) APD2.42cm, RPT0 in the late trimester of pregnancy, RPT0 .27cm, with a RI value of 0.85 of the renal artery, we should focus on the prenatal diagnosis and monitoring of the prenatal ultrasound, and select the appropriate gestational weeks to terminate the pregnancy as necessary. (3) if the fetal renal pelvis expansion is not obviously relieved or progressively aggravated during the postpartum follow-up, it should be highly doubted whether the urinary system is stored or not. In the obstructive disease, be aware of whether the children's renal function is damaged, because most of the fetus with severe pyelonephrosis in the late pregnancy has the symptoms of pathological obstructive hydrops, it is necessary to perform surgical treatment as early as possible to alleviate or fade.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.5

【參考文獻】

相關(guān)期刊論文 前10條

1 王婧霖;劉雨函;呂卓;;超聲評分法及腎動脈阻力指數(shù)對胎兒腎積水預(yù)后的研究價值[J];臨床超聲醫(yī)學(xué)雜志;2014年12期

2 于紅奎;夏焙;林洲;許娜;;兒童腎動脈多普勒超聲正常參考值及其臨床意義[J];中國醫(yī)學(xué)影像技術(shù);2013年08期

3 董大敏;袁冠平;;淺談胎兒腎盂擴張程度與預(yù)后的關(guān)系[J];求醫(yī)問藥(下半月);2013年08期

4 杜文欣;宋殿榮;;胎兒腎積水的病因、診治及預(yù)后研究進展[J];國際婦產(chǎn)科學(xué)雜志;2012年03期

5 羅歡;張惠芳;黃蓉;霍咪;陳協(xié)輝;;三維能量多普勒超聲對原發(fā)性腎小球疾病腎血流灌注的定量評價[J];中國醫(yī)藥導(dǎo)刊;2012年05期

6 黃湖;王亮;寇紅菊;羅洪霞;;65例胎兒腎積水的超聲診斷與預(yù)后觀察[J];實用婦產(chǎn)科雜志;2011年12期

7 范霜月;劉志聰;童建卿;蔡潔;;82例胎兒腎盂擴張的產(chǎn)前診斷與預(yù)后分析[J];現(xiàn)代實用醫(yī)學(xué);2011年05期

8 代莉;周容;;胎兒腎積水的宮內(nèi)治療[J];現(xiàn)代預(yù)防醫(yī)學(xué);2011年06期

9 張欣;李少聞;鄔晉芳;付麗麗;;胎兒腎積水轉(zhuǎn)歸的研究分析[J];中國兒童保健雜志;2010年10期

10 楊星海;楊小紅;丁峰;陳欣林;陳海濤;;腎積水的產(chǎn)前診斷及預(yù)后分析[J];臨床小兒外科雜志;2008年05期

，

本文編號：2115207