| Object:With the widespread use of fetal prenatal ultrasound techniques and the continuous improvement of screening levels,the detection rate of fetal urinary system abnormalities is significantly improved,and a large number of literatures at home and abroad have pointed out that ultrasound is important for monitoring the quantitative classification of fetal renal pelvis separation and postnatal renal outcome,at the same time,the research on the numerical value and classification standard of the degree of separation of renal pelvis has also been done,however,there are few studies on the relationship between the degree of renal pelvis separation and the earliest gestational age.In clinical practice,the diagnosis,treatment and prognosis evaluation of physiological renal pelvis separation and pathological renal pelvis separation during pregnancy are quite different.In this study,the quantitative analysis of the degree of separation of fetal renal pelvis and the outcome of fetal renal pelvis separation in different gestational weeks were monitored by ultrasound technique,and the significance was analyzed.It can provide an information basis for clinical treatment earlier,and make an early assessment of the outcome of the separation of the renal pelvis after birth and the function of the urinary system.Methods:The subjects of this research are selected from patients who came to Hebei Children’s Hospital during the period from January 2017 to December 2018,including:(1)In the outpatient department of Hebei Province Children’s Hospital and hospitalization,the fetuses with renal pelvis separation(178)were detected during routine prenatal ultrasound examination,and the data on the degree of postpartum renal pelvis separation were successfully tracked;(2)in the Department of Ultrasound,Children’s Hospital of Hebei Province,children with urinary tract ultrasound and a history of renal pelvis separation in the fetal period(88),and can provide data on the degree of renal pelvis separation during normal hospital obstetric examination during pregnancy.In this study,according to the routine clinical stage,the mid-pregnancy period was between 14 and 27 weeks,and the late pregnancy was 28 weeks and later.According to the width of the anterior-posterior diameter of the renal pelvis,it is divided into the following three degrees: a mild separation between 5 and 10 mm;a moderate separation between 10 and 15 mm;and a severe separation of 15 mm or more.Follow-up results during pregnancy and postnatal reexamination of renal pelvis separation or renal pelvis separation is not obvious to determine the physiological renal pelvis separation,The degree of separation of renal pelvis during pregnancy or after birth is aggravating trend and to achieve the degree of surgical relief or relief of obstruction after birth is a pathological renal pelvis separation.In the fetal period of this study,the TOSHIBA Aplio500 color ultrasound machine was used for the test.Select the following cut surface for observation: the left and right kidneys of the fetus pass through the long axis section and the short axis section of the renal hilum,the size of the kidney was measured and recorded,the morphology of the kidney was observed,and the kidney structure and development of the fetus were evaluated as a whole.The left and right kidneys of the fetus pass through the short axis of the renal hilum,showing the renal pelvis of the renal hilum.The internal diameter is measured by local amplification and measurement function of the ultrasonic instrument.If the renal pelvis is separated widely or irregular,the separation range is measured.Fetal sagittal section,combined with abdominal cross-section to observe fetal bladder filling and ureteral dilatation,and record the value.In the infant and toddler period,the ALOKA F75 color ultrasound machine was used for the test.After the child is quiet or sedated,select the appropriate scanning path,to avoid the shielding of ribs,intestines and lungs,check the liver or spleen as the acoustic window,and select the following cut surface observation: The left and right kidneys pass through the long axis and short axis of the renal hilum,and the size of the kidney was measured.The kidney morphology,renal pelvis,kidney calices and central collection system were observed.The overall development of the kidney was evaluated;The left and right kidneys pass through the short axis of the renal hilum,showing the renal pelvis of the renal hilum.The internal diameter is measured by local amplification and measurement function of the ultrasonic instrument.If the renal pelvis is separated widely or irregular,the separation range is measured;abdominal cross section and sagittal section,observe the bladder and ureter of the child,If there are other abnormal images of the urinary system,they can be measured together and recorded.Ultrasonic images and measurement data listed above must be measured at least three times under the condition of clear standard section of ultrasonic image quality,each value is recorded and the average is calculated,and the selected images are reviewed by the superior physician,the obtained data is then entered into the database.All images obtained are stored in the PASS system.The collected data were analyzed by SPSS25.0 statistical software,and the measurement data was expressed by x ±s.In this scientific research,paired t-test was used to compare the measurement data.The four-square table chi-square test was used to compare the count data.The difference was statistically significant at P<0.05.Results:1.There are differences in the prognosis of different degrees of renal pelvis separation during the mid-pregnancy There were significant differences in the prognosis of mild to moderate segregation(P<0.05).There were significant differences in the prognosis between mild and severe segregation(P<0.05).There was no significant difference in the prognosis between moderate and severe segregation(P>0.05).2.The prognosis of different degrees of r renal pelvis separation in late pregnancy was different,and the prognosis of mild and moderate segregation was different(P<0.05).3.For mild renal pelvis separation,there was a significant difference in the prognosis between mid-pregnancy and late pregnancy(P<0.05);for moderate renal pelvis separation,there was a significant difference in the prognosis between middle and late pregnancy(P<0.05);for severe renal pelvis separation,there was no significant difference in prognosis between middle and late pregnancy(P>0.05).Conclusion:1.There is a correlation between the prognosis of pregnancy and the degree of renal pelvis separation.2.In the same pregnancy period,the prognosis of mild fetal renal pelvis separation is better than the prognosis of moderate and severe renal pelvis separation.The prognosis of moderate and severe fetal renal pelvis separation is the same.3.In mild and moderate degree of fetal renal pelvis separation,the prognosis in middle pregnancy is better than that in late pregnancy.In severe cases of fetal renal pelvis separation,the prognosis during the prognosis in middle pregnancy and late pregnancy is the same.4.Ultrasonography plays an important role in monitoring the changes in the degree of renal pelvis separation during pregnancy and postpartum,and is of great significance for guiding clinical intervention. |
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