Olbing Hermann, Smellie Jean M, Jodal Ulf, Lax Hildegard
Department of Pediatrics, University Children's Hospital, Essen, Germany.
Pediatr Nephrol. 2003 Nov;18(11):1128-31. doi: 10.1007/s00467-003-1256-4. Epub 2003 Oct 2.
The International Reflux Study in Children was set up to compare prospectively the outcome of medical or surgical management of children with grade III or IV vesicoureteral reflux and a history of symptomatic urinary tract infection. Development of new radiological scars was the main end point. Of the 306 children randomized, 302 (153 medical, 149 surgical) were available for radiological follow-up at 5 years. New scars had developed in 19 medically and 21 surgically treated children. Among 223 patients (113 medical, 110 surgical) who continued follow-up with urography at 10 years, only 2 further new scars developed. Overall, 47 new scars were acquired in 42 patients (20 medical, 22 surgical), 25 of them in children with unscarred kidneys at entry (13 medical, 12 surgical). New scars occurred mostly in children under 5 years of age and were observed more frequently in children with grade IV than grade III reflux. We conclude that with careful management, only a small proportion of children with severe reflux developed new scars and rarely after the first 5-year follow up period, and that there was no difference between children treated medically or surgically.
儿童国际反流研究旨在前瞻性比较患有III级或IV级膀胱输尿管反流且有症状性尿路感染病史的儿童接受药物治疗或手术治疗的结果。新放射学瘢痕的形成是主要终点。在随机分组的306名儿童中，302名（153名接受药物治疗，149名接受手术治疗）在5年时可进行放射学随访。接受药物治疗的19名儿童和接受手术治疗的21名儿童出现了新瘢痕。在10年时继续接受尿路造影随访的223名患者（113名接受药物治疗，110名接受手术治疗）中，仅又出现了2处新瘢痕。总体而言，42名患者（20名接受药物治疗，22名接受手术治疗）出现了47处新瘢痕，其中25处出现在入组时无瘢痕肾脏的儿童中（13名接受药物治疗，12名接受手术治疗）。新瘢痕大多出现在5岁以下儿童中，IV级反流儿童比III级反流儿童更常出现。我们得出结论，通过精心管理，只有一小部分严重反流儿童会出现新瘢痕，且在前5年随访期后很少出现，并且接受药物治疗或手术治疗的儿童之间没有差异。
