Burge D M, Griffiths M D, Malone P S, Atwell J D
Wessex Regional Centre for Paediatric Surgery, Southampton General Hospital, United Kingdom.
J Urol. 1992 Nov;148(5 Pt 2):1743-5. doi: 10.1016/s0022-5347(17)37018-0.
Of 222 infants with a urinary tract abnormality detected antenatally 30 male and 9 female patients (64 renal units) were found to have primary vesicoureteral reflux. Grade of reflux was predominantly severe, with grade III or higher noted in 83% of the patients. Prenatal and postnatal ultrasound failed to detect any abnormality in 29 refluxing units (45%) discovered contralateral to the known abnormal system, although 19 had grade III or higher reflux. Of the 64 refluxing units 8 underwent primary ureteral reimplantation, 12 were lost to followup and 44 were managed conservatively for a mean of 3.3 years. Reflux ceased in 61% of the cases, improved in 14% and remained unchanged in 23%. In only 1 unit did the grade of reflux increase. Documented urinary tract infection occurred in 6 of the 39 reflux patients. Dimercaptosuccinic acid renography performed in 21 infection-free patients demonstrated global reduction in renal parenchyma in 4 units, focal parenchymal defects in 3 and normal function in 14. Conservative postnatal management of fetal vesicoureteral reflux is justified. Global and focal parenchymal changes can occur in the kidneys of infants with reflux despite the absence of urinary tract infection.
在222例产前检测出尿路异常的婴儿中，发现30例男性和9例女性患者（64个肾单位）存在原发性膀胱输尿管反流。反流程度主要为重度，83%的患者反流程度为III级或更高。已知异常系统对侧发现的29个反流单位（45%），产前和产后超声均未检测到任何异常，尽管其中19个反流程度为III级或更高。在64个反流单位中，8个接受了原发性输尿管再植术，12个失访，44个接受了平均3.3年的保守治疗。61%的病例反流停止，14%有所改善，23%保持不变。只有1个单位的反流程度增加。39例反流患者中有6例记录有尿路感染。对21例无感染患者进行的二巯基丁二酸肾图检查显示，4个单位肾实质整体减少，3个单位有局灶性实质缺损，14个单位功能正常。胎儿膀胱输尿管反流的产后保守治疗是合理的。尽管没有尿路感染，但反流婴儿的肾脏仍可能出现整体和局灶性实质改变。
