Läckgren Göran, Wåhlin Nils, Sköldenberg Erik, Nevéus Tryggve, Stenberg Arne
Section of Urology, University Children's Hospital, Uppsala, Sweden.
J Urol. 2003 Oct;170(4 Pt 2):1551-5; discussion 1555. doi: 10.1097/01.ju.0000084672.98131.f7.
Endoscopic injection of dextranomer/hyaluronic acid (Dx/HA) copolymer is an increasingly established treatment for primary vesicoureteral reflux (VUR) in children. We performed a retrospective analysis to assess this treatment for VUR associated with either double ureters or a small kidney.
The study included 68 children with duplex ureters and 40 with a small kidney (1 kidney contributing 10% to 35% of total renal function) who underwent endoscopic treatment with Dx/HA copolymer for VUR. Followup consisted of voiding cystourethrography 3 and 12 months after injection. Positive response was defined as reflux grade 0 or I. As many as 2 repeat injections were offered to nonresponders, and those with persistent reflux were referred for open surgery. Long-term clinical followup with renal function testing was continued for 4 to 9 years.
A positive response was observed in 63% of children with duplex ureters, with only 17 (25%) patients requiring open surgery. Among children with a small kidney the response rate was 70%, and open surgery was performed in 9 (23%). In both treatment groups a positive response to treatment was sustained throughout the followup period in all cases. The treatment was well tolerated, with no complications associated with the procedure.
Endoscopic treatment with Dx/HA copolymer appears to be an effective and well tolerated alternative to open surgery for first line treatment of VUR associated with double ureters or a small kidney.
内镜下注射葡聚糖omer/透明质酸（Dx/HA）共聚物是一种越来越成熟的治疗儿童原发性膀胱输尿管反流（VUR）的方法。我们进行了一项回顾性分析，以评估这种治疗与双输尿管或小肾脏相关的VUR的效果。
该研究纳入了68例双输尿管患儿和40例小肾脏患儿（一个肾脏对总肾功能的贡献为10%至35%），他们接受了Dx/HA共聚物内镜治疗VUR。随访包括注射后3个月和12个月的排尿性膀胱尿道造影。阳性反应定义为反流分级为0或I级。对无反应者最多进行2次重复注射，对持续反流者转诊进行开放手术。继续进行4至9年的长期临床随访及肾功能检测。
双输尿管患儿中有63%观察到阳性反应，只有17例（25%）患者需要进行开放手术。小肾脏患儿中的反应率为70%，9例（23%）进行了开放手术。在两个治疗组中，所有病例在整个随访期间对治疗的阳性反应均持续存在。该治疗耐受性良好，未出现与手术相关的并发症。
内镜下用Dx/HA共聚物治疗似乎是一种有效且耐受性良好的替代开放手术的方法，可作为与双输尿管或小肾脏相关的VUR一线治疗方法。
