소아에서 신우성형술의 결과 분석
Outcome Analysis of Pyeloplasty in Children
김호철, 김광세,
소속 상세정보
김호철 ( )
계명대학교
김광세 ( )
계명대학교 의과대학 비뇨기과학교실
KMID : 0358319970380111196
Abstract
서론
신우요관이행부 폐색은 수신증을 야기할 수 있는 상부요로 폐색의 원인 중 가장 흔한 질
환으로서 이는 요류의 장애를 일으켜 궁극적으로의 손상을 초래한다는 점에서 중요한 의미
를 가진다. 또한 산전 초음파 검사가 널리 시행됨에 따라 이로 인한 태아 수신증의 빈도가
1000당 1명 꼴로 증가하고 있으며, 이중 약 75%가 신우요관폐색을 보인다고 한다. 치료로는
기능장애 분절을 완전히 제거하는 신우성형술(dismembered pyeloplasty)이 가장 널리 이용
되고 있다. 신우성형술후 증싱 및 수신증의 소실은 보고자들에 따라 다르나 90% 이상으로
보고되고 있으며 신기능의 회복도 기대할 수 있다. 하지만 신기능의 회복도 만족할 만한 정
도가 아니다. 따라 근래에는 술후 신기능의 회복에 대한 관심이 모아지고 있다.
저자들은 신우성형술후 신기능과 수신중이 얼마나 회복될 것이며 또한 신기능 회복에 영
향을 미치는 조건들이 무엇인가를 확인하여 보고자 하였다.
#초록#
Purpose: To elucidate factors affecting the outcome of pyeloplasty, we retrospectively
reviewed a consecutive series of children who underwent dismembered pyeloplasty.
Methods: We encountered 37 kidneys in 30 patients with primary UPJ obstruction.
Twenty eight were malt and 2 were female. Sixteen patients (19 renal units) were
younger than 1 year of age. There was a 2.3 : 1 predominance of left side. In all 37
renal units, postoperative calyceal dilatations were compared to those of preoperative
degrees by excretory urography or ultrasonography. In 20 of 23 unilateral disease,
postoperative split renal functions measured by 99mTc MAG-3 or DTPA renal scan
were compared to those of preoperative values. Mean follow up was 48.4 months. To
assess the degree of improvement of renal function and calyceal dilatation, multivariant
analysis was performed by groups according to age, initial presentation, preoperative
split renal fuction, laterality and the degree of preoperative calyceal dilatation.
Results: In patients younger than 1 year, the most common initial presentation was
prenatally detected hydronephrosis (9/16) and in older children, abdominal mass or pain
(10/14). In all 20 patients who had renal scan, split renal function was Improved in 13
(65.0%) and unchanged in 7(35.0%) after the surgery. In 9 kidneys with impaired
preoperative split renal function (less than 35%), renal function was improved greater
than 5% in 8 (88.9%) after the surgery. In the other 11 renal units, the function was
greater than 35% before and after the surgery. The improvement of calyceal dilatation
was noticed in 33 (89.2%) of the renal units and more significant in groups of children
who had high grade (Ⅳ, Ⅴ) hydronephrosis with preoperative renal function of greater
than 35%. The degree of functional improvement was better in groups of patients whose
age were under 12 months and also who had impaired renal function with mild to
moderate calyceal dilatation. The half time clearance was well correlated to the degree
of calyceal dilatation. No one underwent repeated operation.
Conclusions: Dismembered pyeloplasty is strafe and highly successful procedure. The
greatest potential recovery of renal function was noticed in patients with decreased renal
function but mild to moderate hydronephrosis. And the resolution of calyceal dilatation
was most likely in patients with severe hydronephrosis but well preserved renal
function.
키워드
Pyeloplasty; Children;
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