儿童肾盂输尿管连接处梗阻管理范式的转变：从积极手术到基于风险分层的保守治疗

Transition in the Management Paradigm for Pediatric Ureteropelvic Junction Obstruction: From Proactive Surgery to Risk-Stratified Conservative Treatment

摘要: 产前超声筛查的普及得使肾盂输尿管连接处梗阻(Ureteropelvic Junction Obstruction, UPJO)的产前诊断率明显提升，大量证据显示UPJO相关肾积水存在很高的自发缓解倾向，特别是单侧病例里大约80%可经由保守治疗维持肾功能稳定，这一发现推动临床管理策略发生根本性转变，从传统的积极手术干预转变为以超声动态监测为核心结合功能与微观评估的多维度风险分层保守治疗模式，本文围绕怎样通过风险分层实现个体化保守治疗避免不必要的手术干预同时防止肾功能不可逆损伤这一核心问题，系统综述UPJO的风险评估工具、手术指征的循证更新、保守治疗监测方案的有效性及并发症管理策略并对国际指南展开比较分析，文章进一步明确风险分层不仅是医疗决策的工具，也是医患沟通与共同决策的基础。基于风险分层的保守治疗已成为当前UPJO管理的主流模式，能够安全有效地指导临床决策让多数患儿获益。

Abstract: Prenatal ultrasound screening has been widely applied and this has led to a marked rise in the prenatal diagnostic rate of ureteropelvic junction obstruction, accumulating evidence indicates that UPJO-associated hydronephrosis features a high tendency toward spontaneous resolution, especially in unilateral cases around 80% of patients can preserve stable renal function via conservative management, this observation has triggered a fundamental transformation in clinical treatment strategies shifting from traditional aggressive surgical intervention to a multidimensional risk-stratified conservative treatment model that centers on dynamic ultrasound monitoring and integrates functional and microscopic evaluations, this paper focuses on the core issue of how to realize individualized conservative treatment through risk stratification avoid unnecessary surgical procedures and guard against irreversible renal impairment, it systematically reviews risk assessment tools for UPJO evidence-based updates on surgical indications the efficacy of monitoring protocols for conservative treatment and strategies for complication management and also conducts a comparative analysis of international guidelines, the paper further clarifies that risk stratification serves not only as a tool for medical decision-making but also as a foundation for doctor-patient communication and shared decision-making. Conservative treatment based on risk stratification has evolved into the mainstream model for current UPJO management, which can safely and effectively guide clinical decision-making and bring benefits to most affected children.