Choi H, Oh S J, So Y, Lee D S, Lee A, Kim K M
Department of Urology, Seoul National University College of Medicine, Korea.
J Urol. 1999 Sep;162(3 Pt 2):1189-92. doi: 10.1016/S0022-5347(01)68126-6.
Reports of previous studies using excretory urography indicate that significant numbers of new scars developed in 5 to 31% of cases and scarring progressed in 11 to 16% after antireflux surgery. We evaluated renal scarring after surgery using a more accurate method, that is dimercapto-succinic acid renal scintigraphy.
Between 1985 and 1997 antireflux surgery was performed for primary vesicoureteral reflux in 223 children at our hospital. Of these patients 45 boys and 29 girls with a median age of 74 months at surgery in whom preoperative and postoperative renal scans were available form the basis of our retrospective study. Renal scan was performed 0.3 to 58 months (median 2) preoperatively and 5.3 to 44 months (median 18.7) postoperatively. A total of 24 children (39 renal units) were followed further by additional scanning for as long as 25 to 120 months (median 43.2) postoperatively. Each scan was blindly reviewed for the size, number and zone location of cortical defects based on morphology. Interval changes were grouped into categories as improved, no change, progressed and new scar formation.
Postoperatively there was no ureteral obstruction. Pyelonephritis developed in 2 patients (2.7%) and asymptomatic bacteriuria was noted in 35 (47.3%) postoperatively. Of the renal units 110 (86.6%) showed no change, while 15 (11.8%) were improved and 2 (1.6%) had progression. In no case was new renal scar formation observed.
Contrary to most previous reports involving excretory urography, our results indicate no significant progression of renal scarring after antireflux surgery. In most cases postoperative followup renal scans demonstrated no significant morphological change. When there was change, it mostly involved the disappearance or decrease of renal scars.
以往使用排泄性尿路造影的研究报告表明，5%至31%的病例出现了大量新瘢痕，抗反流手术后11%至16%的瘢痕形成有进展。我们使用一种更准确的方法，即二巯基丁二酸肾闪烁显像，评估了手术后的肾瘢痕形成情况。
1985年至1997年间，我院对223例原发性膀胱输尿管反流患儿进行了抗反流手术。在这些患者中，45名男孩和29名女孩，手术时的中位年龄为74个月，术前和术后均有肾脏扫描结果，构成了我们回顾性研究的基础。术前0.3至58个月（中位时间为2个月）和术后5.3至44个月（中位时间为18.7个月）进行了肾脏扫描。共有24名儿童（39个肾单位）在术后进行了长达25至120个月（中位时间为43.2个月）的额外扫描，以进行进一步随访。每次扫描均由专人根据形态学对皮质缺损的大小、数量和区域位置进行盲法评估。间隔期变化分为改善、无变化、进展和新瘢痕形成几类。
术后无输尿管梗阻。2例患者（2.7%）发生肾盂肾炎，35例患者（47.3%）术后出现无症状菌尿。在这些肾单位中，110个（86.6%）无变化，15个（11.8%）有所改善，2个（1.6%）有进展。未观察到新的肾瘢痕形成病例。
与以往大多数涉及排泄性尿路造影的报告相反，我们的结果表明抗反流手术后肾瘢痕形成无明显进展。在大多数情况下，术后随访肾脏扫描显示无明显形态学变化。如有变化，大多表现为肾瘢痕的消失或减少。
