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目的:探讨先天性肾积水患儿产前诊断和早期手术干预的方法及效果。方法:收集2013年6月-2015年6月本院收治的肾盂输尿管连接处狭窄患儿80例,分为产前诊断组和产后诊断组,记录并比较两组患儿的术前病情,术中病理指标,术后恢复情况及并发症发生情况,对14项评价参数的检出率组间比较行r检验,P<0.05时差异有统计学意义。结果:产前诊断组患儿发生肾周感染、黏连9例,脓肾2例,肾切除2例,术前肾造瘘1例;产后诊断组患儿发生肾周感染、黏连40例,脓肾8例,肾切除5例,术前肾造瘘8例,产前诊断组在肾周感染、黏连方面明显优于对照组(χ~2=6.345,P=0.008)。产前诊断组患儿术后多种抗生素联合使用率高于产后组(χ~2=6.455,P=0.008),其他恢复观察指标比较差异无统计学意义(P值均>0.05)。结论:先天性肾积水的产前诊断和及时干预具有重要意义,通过简单易行的超声检查和密切随访可以对病情进行较好的监测,有利于早诊断、早干预。在严格遵守手术适应证和手术操作规范的情况下,早期手术安全可靠,且在术后初期疗效佳,对预防严重并发症和肺、肾功能损伤发挥重要作用。
Objective: To investigate the methods and effects of prenatal diagnosis and early surgical intervention in children with congenital hydronephrosis. Methods: Totally 80 children with ureteropelvic junction in our hospital from June 2013 to June 2015 were divided into prenatal diagnosis group and postnatal diagnosis group, and the preoperative condition and operation of the two groups were recorded and compared In the pathological indicators, postoperative recovery and complications, the detection rate of 14 evaluation parameters were compared between the two groups by r test, P <0.05 difference was statistically significant. Results: In the prenatal diagnosis group, there were 9 cases of peritoneal infection, adhesions in 9 cases, 2 cases of pus in 2 cases, 2 cases of nephrectomy and 1 case of preoperative nephrostomy. In the postpartum diagnosis group, there were 40 cases of perinatal infection and adhesions , 8 cases of pus, 5 cases of nephrectomy and 8 cases of preoperative nephrostomy. The prenatal diagnosis group was significantly better than the control group in peritoneal infection and adhesion (χ ~ 2 = 6.345, P = 0.008). The combined use rate of multiple antibiotics in the prenatal diagnosis group was higher than that in the postpartum group (χ ~ 2 = 6.455, P = 0.008). There was no significant difference between the other two groups (P> 0.05). Conclusion: Prenatal diagnosis and timely intervention of congenital hydronephrosis is of great significance. By simple and easy ultrasound examination and close follow-up, we can monitor the disease well, which is good for early diagnosis and early intervention. In the strict compliance with surgical indications and surgical practices in the case of early surgery safe and reliable, and the early postoperative effect is good, to prevent serious complications and lung and kidney damage play an important role.