Abstract: 【Objective】 To discuss the antenatal sonographic diagnosis of fetal hydronephrosis and to evaluate the prognosis of them.Then to provide help for clinical intervention. 【Methods】 72 fetuses(91 kidneys)received B ultrasound when they were 18~40 weeks pregnant.The anteroposterior diameter and thickness of parenchyma were noted and compared.They were divided into 3 groups,mild,moderate and severe according to the anteroposterior diameter of pyelectasis, then were followed up visitation at special time. 【Results】 In group of mild hydronephrosis,there were 42 kidneys whose hydronephrosis disappeared,4 eased or had no change and 2 aggravated.However,in the group of moderate hydronephrosis,there were 15 kidneys whose hydronephrosis disappeared,2 eased or have no change and 9 aggravated.There were 8 kidneys with the parenchymal thickness less then 5 mm in this group,and 4 of them were operated.And in the group of severe hydronephrosis,2 kidneys whose hydronephrosis eased or have no change and 15 aggravated.There were 11 kidneys with the parenchymal thickness less then 5 mm in this group,and 5 of them were operated. 【Conclusion】 Most of the hydronephrosis with the anteroposterior diameter of renal pelvis less then 15 mm is a physiological change,which can disappear along with individual development.The fetal hydronephrosis which more then 15 mm and parenchymal thickness being less then 5mm shoud be obsevered periodically.If the hydronephrosis remain stabilized or become more severe,we must pay more attention or peform the operation.

Key words: hydronephrosis, prenatal diagnosis, veating

摘要： 【目的】 探讨胎儿肾积水的产前诊断及不同积水程度的转归,为临床干预提供帮助。 【方法】 在孕中晚期超声检查发现的疑似病例中,选择肾盂前后径分离值≥7 mm的胎儿72例(91侧),测量肾盂分离前后径及肾皮质厚度,按肾盂扩张前后径(<10 mm,10~15 mm,>15 mm)分为轻、中、重度3组,3组均进行产前产后随访。 【结果】 41例(48侧)轻度肾积水胎儿,随访过程中有42侧肾积水消失,4侧肾积水减轻或未变化,2侧肾积水加重,于后期行手术治疗。19例(26侧)中度肾积水胎儿,随访过程中有15侧肾积水消失,2侧肾积水减轻, 9侧肾积水加重。其中肾皮质厚度在5 mm以下的8侧肾,有4例积水程度加重,于后期行手术治疗。12例(17侧)重度肾积水胎儿2侧肾积水未变化,15侧肾积水加重。其中肾皮质厚度在5 mm以下的11侧肾,有3例积水程度加重,于后期行手术治疗。 【结论】 胎儿肾盂扩张<15 mm且肾皮质厚度＞5 mm多数是生理性过程,肾盂扩张＞15 mm且肾皮质厚度<5 mm应加强随访,如肾盂扩张无进行性增宽多提示预后良好,如分离程度大且持续存在甚至加重,多提示预后不良,需密切观察或手术治疗。

关键词: 肾积水, 产前诊断, 转归