Barrieras D, Lapointe S, Reddy P P, Williot P, McLorie G A, Bägli D, Khoury A E, Merguerian P A
Hospital for Sick Children, University of Toronto, Ontario, Canada.
J Urol. 1999 Sep;162(3 Pt 2):1197-200. doi: 10.1016/S0022-5347(01)68130-8.
We evaluated the outcome and incidence of urinary retention after bilateral detrusorrhaphy using 2 modifications of the original Lich-Gregoir procedure.
We evaluated the charts of 220 patients who underwent correction of bilateral vesicoureteral reflux using the extravesical approach from January 1991 to December 1997. Inverted Y detrusorrhaphy was performed in 154 patients and the advancing suture modification was done in 66.
The success rate using the advancing suture technique was 92.4 and 95.4% at 3 and 12 months, respectively. The Y detrusorrhaphy technique was successful in 91.6 and 97.4% of cases at 3 and 12 months, respectively. The difference in the techniques was not statistically significant. Urinary retention developed in 8.4% of the patients who underwent Y detrusorrhaphy compared to 15.2% of those who underwent the advancing suture technique (not statistically significant). However, patients with grades IV and V reflux, children younger than 3 years and boys had significantly (p <0.05) higher postoperative retention rates of 24.6, 35.6 and 20.3%, respectively, when all 220 patients were considered.
Each modification of the original Lich-Gregoir technique is highly effective for treating bilateral vesicoureteral reflux and each is associated with a low rate of temporary urinary retention. Although there seems to be a lower incidence of retention with the Y detrusorrhaphy technique, this was not statistically significant. Because of the higher incidence of urinary retention in young children, boys and/or patients with high grade reflux, we recommend that physicians consider a longer period of catheterization regardless of the technique chosen.
我们使用对原始利奇-格雷戈尔手术的两种改良方法，评估了双侧逼尿肌缝合术后的结果及尿潴留发生率。
我们评估了1991年1月至1997年12月期间采用膀胱外入路进行双侧膀胱输尿管反流矫正的220例患者的病历。154例患者采用倒Y形逼尿肌缝合术，66例采用推进缝合改良术。
推进缝合技术在3个月和12个月时的成功率分别为92.4%和95.4%。Y形逼尿肌缝合技术在3个月和12个月时分别有91.6%和97.4%的病例成功。两种技术之间的差异无统计学意义。接受Y形逼尿肌缝合术的患者中有8.4%发生尿潴留，而接受推进缝合技术的患者中这一比例为15.2%（无统计学意义）。然而，当考虑所有220例患者时，IV级和V级反流患者、3岁以下儿童以及男孩术后尿潴留发生率显著更高（p<0.05），分别为24.6%、35.6%和20.3%。
对原始利奇-格雷戈尔技术的每种改良方法在治疗双侧膀胱输尿管反流方面都非常有效，且每种方法导致的暂时性尿潴留发生率都较低。尽管Y形逼尿肌缝合技术的尿潴留发生率似乎较低，但无统计学意义。由于幼儿、男孩和/或重度反流患者尿潴留发生率较高，我们建议医生无论选择何种技术，都应考虑延长导尿时间。
