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目的通过泌尿系统超声筛查,了解闵行区高危儿童泌尿系统发育异常发生情况,并通过建立三级管理网络,早期发现和及时转诊重症肾脏畸形患儿,有助于及早治疗和预后。方法对由闵行区各社区卫生服务中心转至闵行区妇幼保健院的高危儿童进行泌尿系统超声筛查,筛查阳性结果分为先天性肾积水、其他肾脏发育异常。对先天性肾积水患儿进行后续随访和转诊。结果 2011年1月-2012年12月由闵行区各社区卫生服务中心转入本院的高危儿童6 258例,接受泌尿系统超声筛查者5 325例,筛查率为85.09%,2012年度明显高于2011年(82.19%vs 87.47%,χ2=33.82,P<0.05)。筛查阳性513例,占全部筛查儿童的9.63%,其中先天性肾积水最为常见,占9.37%(496/513),轻、中、重度分别占79.84%(396/496)、18.35%(91/496)、1.81%(9/496);0~3月异常检出明显多于4~6月及7~12月(χ2=13.435,χ2=7.252,P均<0.01)。其他肾脏异常13例,泌尿系统外异常6例(其中2例合并肾积水)。41例需转诊至三级儿童专科医院,其中28例完成转诊,二级至三级医院转诊到位率约70%;轻中度肾积水本院门诊随访率52.12%(234/449)。结论有必要在高危儿童中进行肾脏超声筛查;建立和完善肾脏超声筛查三级网络转诊体系有助于严重泌尿系统畸形的早发现、早诊断和早治疗,早期开展异常检出率较高。对于轻中度肾积水,可结合妇幼保健系统儿童常规体检进行规范随访,但需要三级儿童专科医院肾脏科、超声科等相关科室的定期专业培训和指导。
Objective To investigate the prevalence of urinary system dysplasia in high-risk children in Minhang district through ultrasound screening of urinary system. Early detection and timely referral of children with severe renal malformation by establishing a three-level management network are helpful to early treatment and prognosis. Methods Urinary system ultrasound screening was conducted in high-risk children who were transferred from Minhang District Community Health Service Center to MCH hospital in Minhang District. The screening results were divided into congenital hydronephrosis and other kidney abnormalities. Follow-up and referral of children with congenital hydronephrosis. Results From January 2011 to December 2012, 6 258 high-risk children transferred to our hospital from community health service centers in Minhang District received 5 325 cases of urinary system ultrasound screening with a screening rate of 85.09% Higher than in 2011 (82.19% vs 87.47%, χ2 = 33.82, P <0.05). Among them, congenital hydronephrosis was the most common, accounting for 9.37% (496/513), 79.84% (396/496) and 18.35% (mild, moderate and severe), respectively (91/496) and 81.1% (9/496) respectively. The number of anomalies detected in 0-3 months was significantly higher than that in April-June and July-December (χ2 = 13.435, χ2 = 7.252, P <0.01). Other renal abnormalities in 13 cases, 6 cases of abnormal urinary system (including 2 cases of hydronephrosis). 41 cases were referred to a tertiary specialized hospital, of which 28 cases were referred, the second and third level hospital referral rate was about 70%; mild to moderate hydronephrosis hospital follow-up rate was 52.12% (234/449 ). Conclusion It is necessary to carry out ultrasound screening of kidneys in high-risk children. Establishing and perfecting the three-level network referral system of renal ultrasound screening is helpful for the early detection, early diagnosis and early treatment of severe urological malformations. high. For mild to moderate hydronephrosis, maternal and child health system can be combined with regular physical examination for follow-up, but need three-level children’s hospital nephrology, ultrasound and other relevant departments of regular professional training and guidance.