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B超检出胎儿肾积水还能留吗

发布者: 4343| 查看: 817084| 评论: 4|原作者: tytyty

摘要: 因种种原因,小珊在变成大龄青年之后才结婚,婚后三年多,小珊怀孕了,这可乐坏了小珊夫妇。小珊的丈夫无微不至地照顾着小珊,生怕有什么闪失。小珊自己也很重视,她对自己说,怀胎这十个月,千万不能出什么差池 ...
B超检出胎儿肾积水还能留吗
  因种种原因,小珊在变成大龄青年之后才结婚,婚后三年多,小珊怀孕了,这可乐坏了小珊夫妇。小珊的丈夫无微不至地照顾着小珊,生怕有什么闪失。小珊自己也很重视,她对自己说,怀胎这十个月,千万不能出什么差池,自己已经不年轻了,这第一胎要是保不住,以后麻烦事就多了。    
  孕期检查,胎儿肾积水
  受过教育的她深知产前检查的重要性,怀孕6个月时,她到保健院做了常规检查和B超检查之后,医师郑重告诉她胎儿有肾积水,又叮嘱她要定期到医院复查。检查结果让夫妻俩忐忑不安,小珊更是焦急得连觉都睡不着。
  3周后,小珊去复查,医生非常肯定地说:胎儿右肾有较多的积水,而且比3周前还稍有增多。小珊夫妇为此多次咨询了小儿泌尿外科医生。在医生耐心的解释下,小珊终于明白了何谓肾积水。面对现实,小珊夫妇矛盾重重,左右为难。堕胎吧,又舍不得这宝贵胎儿,生下来嘛,又怕后患多多,这样的味儿叫人真难受。一提到这事,小珊就掉眼泪,直慨叹自己命不好。
  事有凑巧,邻村的亲戚珍姑周末来串门,得知此事,她爽快地说开了。原来她在怀孕时,胎儿也有肾积水,出生后多次复查,发现积水慢慢增多。平常似乎没什么异样,直到宝宝一周岁时,有一天宝宝突然哭闹起来,而且这一闹就是一整天,带到医院做详细检查,才知道原来是肾积水引起腹痛,随即做了手术。最近又去做了术后复查,除尚有轻度肾积水外,其他没什么异常了。珍姑的亲身经历让小珊看到了一丝希望,使她坚定了把孩子生下来的决心。她决定,无论如何,先把宝贵胎儿生下来再说。
  结果又是如何呢?宝宝出生后15天,超声波检查提示右肾重度积水,医生建议尽快手术。当宝宝快满月的时候,经检查确诊右肾巨大积水,已无功能,不得已做了右肾摘除术。
  小珊怎么都想不通,为何同样是肾积水,亲戚珍姑的孩子能逃过一劫,自己的孩子却躲不过。
  还在娘胎里,哪来肾积水
  胚胎在第3个月末时,肾输尿管等器官的发生和演化已完成,随后进入发育成熟阶段。胎龄18周时,肾脏开始泌尿,尿液进入肾盂,经输尿管流至膀胱,膀胱胀满尿液时会经尿道排出,在B型超声波影像下有时可看到胎儿正在拉尿的过程。
  先天性肾积水是指肾盂输尿管连接处有不完全的梗阻,肾盂里的尿液不能十分顺畅排出而导致肾盂压力升高,时间一长,肾盂慢慢扩张,形成了肾积水,梗阻严重时肾积水往往也较大。引起梗阻的原因有多种,多是上段输尿管有先天缺陷,如输尿管腔内的黏膜皱缩形成瓣膜;管壁肌层的结构、发育异常,过于肥厚或有瘢痕,或蠕动功能有缺陷等。少数是外压性的,如异位的血管,先天索条瘢痕压迫,最终引起梗阻性肾积水。胎儿期肾积水可以是轻度的仅1~2厘米,也可能大至7~8厘米不等。少数双侧严重肾积水胎儿,因尿液潴留在胎儿体内,排尿量可减少,因而羊水量亦可减少,羊水过少又可致胎儿的肺、胸廓等发育不良,造成恶性环境下胎儿多发畸形。先天性肾积水是偶发的,不属遗传病,因此,小孩患有先天性肾积水时,既不怨父也不怨母,只怪自己运气不好。
  如何发现肾积水
  现代科技的发展,使得对肾积水的诊断能做到早而准,产前做B超检查几乎是无创的,是最为方便、经济的一项检查。在我国,这项检查已普及到基层妇幼保健院,被列为产前的常规检查。怀孕6个月左右,胎儿肾脏就有尿液分泌了,若有肾盂扩张肾积水,在B超下极容易发现,能准确了解其大小、位置,短期内可多次复查。对胎儿可疑肾积水者,出生后可及时追踪。其他影像学检查如CT、MRI等,在产前是很少需要做的,但出生后尤其在围手术之前,应做静脉肾盂造影或CT或MRI检查,以确定诊断。
  胎儿肾积水怎么办
  产前做B超检查发现胎儿肾积水时,往往会给父母及长辈们带来担忧,他们急于找有关的专业人士咨询,以便做出果断的处理,这里面不能做简单回答,需根据具体情况做出选择。正常人有两个肾,胎儿若有一个肾严重积水,那么,在婴幼儿期剩下的一个好肾会代偿性增大,其功能足以保证维持终身不会出现尿毒症。当然,无功能的积水肾必需摘除。因为无功能肾可产生肾素,这种物质会引起肾性高血压等全身性病变。若胎儿有轻度的一侧肾积水,在新生儿期逐渐增大,那么适时手术治疗,去除梗阻因素,绝大多数患儿能保留肾且终身处于平衡而良好的状态。
  是不是凡有肾积水都要手术呢?这倒不一定。正常肾盂容量随年龄而变,1岁以下约为1毫升,以后每长1岁肾盂容量约增加1毫升,至青春期约为7~8毫升。轻度肾积水,随诊中保持平稳不明显增大者可暂时不手术,但有逐渐增大的中度积水则宜限期手术。肾盂容量大于正常的5倍以上可作为中度肾积水的参考标准,但不能作为衡量肾功能的数据。临床上约有20%患儿有双侧肾积水,如果属于中度或重度肾积水,双肾功能均有明显损害而又未能及时治疗者,可逐渐恶化进入尿毒症阶段,若合并感染,肾功能可迅速恶化,以致肾衰死亡。因此,对双肾积水应高度重视,治疗上也应更加主动积极,视具体情况分期或同期做肾盂输尿管整形术,保证肾功能在正常范围内。
  尚有一定功能的积水肾在成功的手术后,肾功能会进一步改善,肾盂的形态也会有所好转并缩小,临床上无任何不适。但已经扩张的肾盂和变薄的肾实质,即使术后若干年也不可能恢复正常形态,进行B型超声波检查时,医生会告诉你仍有肾积水,这种情况往往伴随一生,这种不会恶化的肾积水对健康无影响,故不必害怕。
               

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