KẾT QUẢ ỨNG DỤNG XẠ HÌNH THẬN ĐỘNG TẠI BỆNH VIỆN NHI ĐỒNG THÀNH PHỐ

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Tác giả: Chí Hiếu Nguyễn, Phát Trần, Vũ Trường Giang Trần, Hữu Quân Trương

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Điện quang và Y học hạt nhân Việt Nam, 2023

Mô tả vật lý: tr.76-85

Bộ sưu tập: Báo, Tạp chí

ID: 372370

Thêm vào giỏ Liên kết toàn văn

Background: Dynamic renal scan has become one of the most effective techniques to investigate the kidney parenchymal function, also the urine collecting and drainage system, in both adults and children. Compared with adults, it is the most commonly used test in children and accounts for more than half of the indications for nuclear medicine unit. In City Children's Hospital, dynamic renal scan has been implemented since the beginning of 2018 and initially showed its clearly role in facilitating the decision on treatment and follow-up strategy of pediatric patients. Therefore, we carry out this study to evaluate the results of dynamic renal scan application of the unit. Objective: To assess the results of application of dynamic renal scan with 99mTc-DTPA on pediatric patients in City Children's Hospital. Subject and method: We retrospectively examined data derived from 671 pediatric patients aged 01 month to 15 years in City Children’s Hospital who underwent at least 1 99Tc DTPA dynamic renal scan with diuretic challenge test from June 2018 to March 2022. The main purpose is to investigate some of the scintigraphic features related to Hydronephrosis in children and the prognostic factors of renal function loss. Results: There were a total of 740 performed scans, including 611 patients underwent once, 52 patients underwent twice, 7 patients underwent threetimes and 1 patient underwent fourtimes. Among them, there are 454 boys and 217 girls with a male/female ratio of 2/1. The age of the pediatric patients at the time of scanning varied, from 1 month to 15 years old. However, there is a clear dominant distribution for the group of patients under 5 years old, accounting for 516 cases (~69.7%%), which is more than 3 times the number for the group of patients aged 5 to 10 years and about 10 times for the group of patients over 10 years old, 175 cases (~23.7%) and 49 cases (~6.6%) respectively. Many different geographical locations in the country, where the patients come from, were noted. However the majority of cases live in Ho Chi Minh City, the number is 218 cases, accounting for ~30% of the total, followed by the west provinces and provinces from central region, as well as the Highlands area. For pre-acquisition diagnosis, after reviewing the anatomical imaging results, there were 436 patients (~65.0%) had a condition of left hydronephrosis/hydroureteronephrosis. 154 patients (~ 23.0%) had a condition of right hydronephrosis/hydroureteronephrosis, 74 patients (~ 11.1%) had a condition of bilateral hydronephrosis/hydroureteronephrosis, and the remains, including 6 children (~0.9 %) had following medical conditions: 02 children with neurogenic bladder, 02 children with right kidney polycystic dysplasia, 01 child with left kidney tumor and 01 child has renal tubular disease. For imaging interpretation, in the group of left hydronephrosis/hydroureteronephrosis (N = 436), there were 163 patients (~ 37.3%), who had impaired renal function (DRF <
40 %), 323 patients (~ 74.0%) had urinary tract obstruction (T half index prolongs more than 20 minutes, 99 patients (~ 22,7%) had urinary tract obstruction accompanied with impaired renal function, 37 patients (~ 8,4%) had severe impaired renal function inducing difficulty in urinary obstruction detection. In the group of right hydronephrosis/hydroureteronephrosis (N = 154), 44 patients (~ 28.5%) had impaired renal function, 69 patients (~ 44.8%) had urinary tract obstruction, 24 patients (5,5~ 1%) had urinary tract obstruction accompanied with impaired renal function. 5 patients (~ 3,2%) had severe impaired renal function inducing difficulty in urinary obstruction detection. Similarly, in the group of bilateral hydronephrosis/hydroureteronephrosis (N = 74), 31 patients (~ 41.8%) had impaired renal function in one or both kidneys, 45 patients ( ~ 60.0%) had urinary tract obstruction on one or both sides, 02 patients (~ 2,7%) had urinary tract obstruction accompanied impaired renal function, 6 patients (~ 8,1%) had severe impaired renal function inducing difficulty in urinary obstruction detection. In addition, among pediatric patients who underwent at least 2 scans (N = 60), 18 patients (~ 30,0 %) progressed to impaired renal function (DRF decreases more than 5 %) and 08 patients (~ 13,3%) appeared increasing urinary obstruction (change to upsloped timeactivity curve). The intervals between follow-up scans varied from 03 months to 24 months, however, most of these cases were detected within 12 months since the first scan. As a result, we found that among 671 patients in the first scan, there were 125 cases (~ 18.6%) of urinary tract obstruction accompanied impaired renal function and among 60 patients with at least 2 scans, there were 18 cases (~ 30,0 %) found to have impaired renal function in the follow-up scans. This is the pediatric group at risk of progressing to loss of kidney function. Conclusion: Dynamic renal scan with 99mTc DTPA has been currently one of the important tools in the diagnosis and follow-up strategy of hydronephrosis/ hydroureteronephrosis in pediatric patients, especially the role of early detection of kidney at risk of progression to loss of function, which helps determine timely intervention measures to preserve kidney function. The application of this technique in City Children's Hospital has initially shown the benefits as an effective imaging for treatment decision besides other imaging studies.Đặt vấn đề: Xạ hình thận động từ lâu đã trở thành một trong những kỹ thuật hữu ích khảo sát chức năng của thận và hệ thống bài xuất, đào thải nước tiểu ở cả người lớn và trẻ em. So với người lớn, đây là xét nghiệm được ứng dụng rộng rãi hơn cả và chiếm hơn nửa số chỉ định bệnh nhi đến với đơn vị xạ hình. Tại bệnh viện Nhi đồng thành phố, xạ hình thận động đã được triển khai từ đầu năm 2018 và bước đầu cho thấy vai trò của nó trong việc hỗ trợ quyết định theo dõi và điều trị trên các bệnh nhi. Do đó, chúng tôi thực hiện nghiên cứu này nhằm thống kê và đánh giá kết quả hoạt động của đơn vị. Mục tiêu nghiên cứu: Đánh giá kết quả ứng dụng kỹ thuật xạ hình thận động với dược chất phóng xạ 99mTc-DTPA trên bệnh nhân trẻ em tại Bệnh viện Nhi đồng thành phố. Đối tượng và phương pháp nghiên cứu: Nghiên cứu hồi cứu mô tả cắt ngang dựa trên hồ sơ bệnh án và kết quả chụp xạ hình thận động sử dụng 99mTc – DTPA có test lợi tiểu của 671 bệnh nhi từ 01 tháng đến 15 tuổi được ghi hình ít nhất 1 lần tại Bệnh viện Nhi đồng thành phố từ tháng 06 năm 2018 đến tháng 03 năm 2022. Mục đích chủ yếu nhằm khảo sát một sốt đặc điểm xạ hình liên quan đến bệnh lý thận ứ nước (Hydronephrosis) ở trẻ em và các yếu tố tiên lượng mất chức năng thận. Kết quả: Có tổng cộng 740 lần ghi hình bao gồm 611 trẻ chụp 1 lần, 52 trẻ chụp 2 lần, 7 trẻ chụp 3 lần, 1 trẻ chụp 4 lần. Trong đó, có 454 trẻ nam và 217 trẻ nữ với tỉ lệ nam/nữ là 2/1. Độ tuổi của các bệnh nhi tại thời điểm xạ hình dao động khá nhiều, từ 01 tháng cho đến 15 tuổi. Tuy nhiên, có sự phân bố ưu thế rõ ràng đối với nhóm bệnh nhi dưới 5 tuổi, chiếm 516 trường hợp (~69,7%%), gấp khoảng hơn 3 lần số lần chụp đối với nhóm bệnh nhi từ 5 đến 10 tuổi và gấp khoảng hơn 10 lần so với nhóm bệnh nhi trên 10 tuổi, lần lượt là 175 trường hợp (~23,7%) và 49 trường hợp (~6,6%).Các bệnh nhi xạ hình đến từ nhiều vị trí địa lý khác nhau trong cả nước, tuy nhiên phần lớn các trường hợp nằm trong địa phận thành phố Hồ Chí Mính với 218 trường hợp, chiếm ~ 30% tổng số, theo sau đó là từ các tỉnh miền tây và miền trung, cũng như khu vực Tây Nguyên. Về mặt chẩn đoán trước xạ hình, sau khi đã xem xét kết quả hình ảnh học giải phẫu, ghi nhận có 436 bệnh nhi (~65,0 %) có tình trạng Thận trái ứ nước có/không kèm dãn niệu quản cùng bên, 154 bệnh nhi (~ 23,0 %) có tình trạng Thận phải ứ nước có/ không kèm dãn niệu quản cùng bên, 74 bệnh nhi (~ 11,1 %) có tình trạng Thận ứ nước hai bên có/không kèm dãn niệu quản, và một số ít còn lại gồm 6 bệnh nhi (~ 0,9 %) có các tình trạng bệnh lý như: 02 trẻ có bàng quang thần kinh, 02 trẻ có thận phải loạn sản đa nang, 01 trẻ u thận trái và 01 trẻ có bệnh lý ống thận. Về mặt đánh giá kết quả xạ hình, trong nhóm bệnh nhi Thận trái ứ nước có/không kèm dãn niệu quản cùng bên (N = 436), ghi nhận 163 trẻ (~ 37,3 %) có suy giảm chức năng thận (chức năng tương đối DRF <
40 %), 323 trẻ (~ 74,0 %) có tắc nghẽn đường bài niệu (chỉ số T½ kéo dài trên 20 phút), 99 trẻ (~ 22,7%) có tắc nghẽn đường bài niệu kèm suy giảm chức năng thận, và 37 trẻ (~ 8,4 %) có suy giảm chức năng thận nặng gây hạn chế trong việc khảo sát tắc nghẽn đường bài niệu. Trong nhóm bệnh nhi Thận phải ứ nước có/không kèm dãn niệu quản cùng bên (N = 154), ghi nhận 44 trẻ (~ 28,5 %) có suy giảm chức năng thận, 69 (~ 44,8 %) có tắc nghẽn đường bài niệu, 24 trẻ (~ 15,5%) có tắc nghẽn đường bài niệu kèm suy giảm chức năng thận, 5 trẻ (~ 3,2 %) có suy giảm chức năng thận nặng gây hạn chế trong việc khảo sát tắc nghẽn đường bài niệu. Tương tự, trong nhóm bệnh nhi Thận ứ nước hai bên có/không kèm dãn niệu quản (N = 74), ghi nhận 31 trẻ (~ 41,8 %) có suy giảm chức năng thận ở một trong hai thận, 45 trẻ (~ 60,0 %) có tắc nghẽn đường bài niệu ở một hoặc hai bên, 02 trẻ (~ 2,7 %) có tắc nghẽn đường bài niệu kèm suy giảm chức năng thận, và có 6 trẻ (~ 8,1 %) có suy giảm chức năng thận nặng gây hạn chế trong việc khảo sát tắc nghẽn đường bài niệu. Thêm vào đó, ở tất cả bệnh nhi được thực hiện ít nhất 2 lần xạ hình (N = 60), ghi nhận có 18 trẻ (~ 30,0 %) phát hiện suy giảm chức năng thận (DRF giảm trên 5 % khi theo dõi) và có 8 trẻ (~ 13,3%) gia tăng tình trạng tắc nghẽn đường bài niệu (biểu hiện bằng sự thay đổi đường cong hoạt độ phóng xạ theo thời gian). Khoảng cách thời gian xạ hình theo dõi dao động từ 3 tháng đến 24 tháng, tuy nhiên đa phần các trường hợp này phát hiện trong vòng 12 tháng đầu từ lần xạ hình đầu tiên. Như vậy, chúng tôi nhận thấy trong 671 bệnh nhi xạ hình lần đầu, có 125 trường hợp (~ 18,6 %) dãn đài bể thận niệu quản kèm suy giảm chức năng thận và trong 60 bệnh nhi xạ hình theo dõi ít nhất 2 lần, có 18 trường hợp (~ 30 %) phát hiện suy giảm chức năng thận ở các lần ghi hình sau. Đây là nhóm đối tượng có nguy cơ diễn tiến đến mất chức năng thận. Kết luận: Xạ hình thận động với 99mTc DTPA hiện nay vẫn còn là một trong những công cụ quan trọng trong việc chẩn đoán và theo dõi bệnh lý thận ứ nước ở trẻ em, đặc biệt là vai trò phát hiện sớm tình trạng thận có nguy cơ diễn tiến đến mất chức năng nhằm mục đích có biện pháp can thiệp kịp thời để bảo tồn chức năng thận. Việc ứng dụng kỹ thuật này tại Bệnh viện Nhi đồng thành phố bước đầu đã cho thấy những lợi ích mang lại cho bệnh nhi cũng như nhà thực hành lâm sàng một công cụ đắc lực cho quyết định điều trị bên cạnh các kỹ thuật hình ảnh học khác.

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