| IntroductionHydronephrosis is a more common disease in pediatric department of urinary surgery.Also simultaneously it is a disease in diagnosing, treatment and prognosis to exist to dispute. The most commonn cause of pediatric hydronephrosis is the ureteropelvic junction stenosis, to call for short UPJS. Along with pathogenesis' going,most pelvis and kidney calices of moderate and severe hydronephrosis will appear progressive aggravate. When it begin to oppress the renal parenchyma, the dilated kidney calices influences the side kidney's function.The extent of kidney impairment oftens involve how to choose treatment method and prognosis curative effect, therefore it is constantly a hot spot in clinical research to explore the effective method to examine the function of diseased kidneys before and after an operation.The kidney is one of the organs in enriching blood. The condition of vascular resistance inside the kidney can not only indirectly reflect the function of the kidney,but also contribute to comprehend pathological state of kidney. With ultrasound instrument's continuously renewal, it make the color doppler flow imaging more and more sensitive in the examination of the blood speed.There is a research indicating that only segment artery blood may be displayed to 100%, and the change of kidney segment artery blood parameters can represent blood dynamics variety of the whole kidney.This research aims at indirectly evaluating kidney's function and postoperative curative effect according to the variety of kidney segment artery RI value before or after an operation.Materials and methods1. Investigated objects The case group:40 total unilateral hydronephrosis children in our hospital who had operation treatment respectively during July,2007 and December,2009.A11 of those were proceeded the examination of color doppler ultrasound before the operation.And the cause of hydronephrosis were all ureteropelvic junction stenosis after the operation. This group included male 36, female 4, age one month-14 years old, the average age was 4.4 years old.The normal matched control:60 children, the male was 52, the female was 8, age one month-14 years old, each age group was 20 for each.2. Equipments and Ultrasonography MethodsUltrasonic examination used IU22 3D color ultrasonic scanner of PHILIPS company, with a 2-5 MHz convex array transducer.Diseased children made bladder fill moderately when examined, take a side to lie, enlarged the picture appropriately at the kidney coronal section, respectively sampling the upper pole, middle and anus perineum of the kidney to measure renal parenchyma thickness and take average value as the final measurement value.Display the blood signal of vascular bed inside the kidney, make the pulse doppler ultrasound respectively sampling the upper pole, middle and anus perineum of the kidney to measure segment artery resistance index and take average value as the finally measurement value.When examing,make sampling volume and segment artery major axis parallelism, and appearing 3-5 blood frequency spectrums of continuous likenesses,we began to carry on reading a number.3. Statistics methodsAll results adopt SPSS 14.0 software to carry on a statistics. Measurement data all use average±standard deviation to express, make a t test, one-factor analysis of variance, repeated-measure analysis of variance, pearson correlation analysis.(P>0.05 The difference is not statistically significant,P<0.05 the difference is statistically significant, P<0.01 the difference is notable statistically significant.)Results1. The children in each age group of normal matched controls, the change of kidney segment artery resistance index and renal parenchyma thickness both display significant difference (P<0.01).Along with the growth of age, the segment artery resistance index lowers gradually, renal parenchyma thickness increases thicker gradually, presenting to show significant negative correlation between them.2. The segment artery resistance index of diseased kidney in each age group is higher than that of the normal matched control group,but the difference isn't significant among different age groups in case group,indicating that the segment artery resistance index of the diseased kidney has nothing to do with the age.3. The segment artery resistance index of diseased kidney in the severe hydronephrosis group is higher than that of midrange hydronephrosis group, namely along with hydronephrosis'aggravating, the segment artery resistance index of the kidney continuously goes up.4. Two months after operation,the segment artery resistance index of diseased kidney is lower than before both in midrange and severe hydronephrosis children,p<0.05,but the difference is not significant when comparing it with that six months,one year after the operation,p>0.05,indicating that the resistance index of diseased kidney of hydronephrosis children will ameliorate significantly within two months after operation.Then the value of resistance index goes stabile,indicating that the resistance of blood vessels decreases within two months after operation and the supplement of blood increases,making for the recovery of the function of diseased kidneys.5. Comparing the renal parenchyma thickness after six months with that before,after two months between midrange and severe hydronephrosis children,p<0.01,while comparing it with that after one year,p>0.05,indicating that the renal parenchyma thickness of diseased kidney ameliorates significantly within six months after the operation;comparing the renal parenchyma thickness of the midrange with that of the severe hydronephrosis,p>0.05,indicating that the renal parenchyma thickness of midrange hydronephrosis group is higher than that of severe group significantly,more approaching the normal value,but the speed of revovery of the severe group is more swift.6. The resistance index and renal parenchyma thickness show negative correlation between them,p<0.05. Conclusion1. In this study,more severer, more higher,the segment artery resistance index of diseased kidney is. We can according to this value indirectly reflect the degree of hydronephrosis.2. When the hydronephrosis children receive the operation to relieve the obstruction of diseased kidney,the segment resistance index of diseased kidney is lower than before,accordingly,the renal parenchyma thickness is thicker. The resistance index goes stable within two months when the operation finished.That indicates the change of the segment arteries resistance index of the diseased kidney can prompt the recovery of kidney function and help the clinical surgeons valuate the cure effect after operation. |
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