自体软骨细胞内镜治疗膀胱输尿管反流：术后超声特征

Endoscopic treatment of vesicoureteral reflux with autologous chondrocytes: postoperative sonographic features.

作者信息

Paltiel Harriet J, Diamond David A, Zurakowski David, Drubach Laura A, Atala Anthony

机构信息

Department of Radiology, Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.

出版信息

Radiology. 2004 Aug;232(2):390-7. doi: 10.1148/radiol.2322030551. Epub 2004 Jun 23.

DOI:10.1148/radiol.2322030551

PMID:15215550

Abstract

PURPOSE

To analyze sonographic imaging features of renal collecting systems, ureters, and bladder in 32 children after endoscopic treatment of vesicoureteral reflux with autologous chondrocytes and to determine whether any features are associated with persistent reflux.

MATERIALS AND METHODS

Sonograms obtained at mean intervals of 1.4 and 12 months after treatment were compared with cystograms obtained at mean intervals of 2.7 and 12 months. Sonograms were analyzed for chondrocyte mound contour and volume, changes in mound volume over time, and presence of hydroureteronephrosis. Mean differences in mound volume were detected with paired t tests in 14 patients with early and late sonograms available for review.

RESULTS

Early cystograms and sonograms were available for 25 of 32 patients (45 of 56 treated ureters). Reflux occurred in 16 of 45 ureters. In 16 ureters, chondrocyte mounds were absent in six, unilobed in seven, and multilobed in three. In 29 treated ureters without reflux, mounds were unilobed in 28 and multilobed in one. Three patients had mild hydronephrosis and one had distal hydroureter; these conditions resolved. Late cystograms and sonograms were available in 18 of 22 patients (30 of 38 treated ureters). Reflux occurred in seven of 30 ureters. In seven ureters, mounds were unilobed in five and multilobed in two. In 23 treated ureters without reflux, mounds were unilobed in 21 and multilobed in two. One patient had mild hydronephrosis that resolved. In 14 patients with early and late sonograms available for review, mean mound volume in late group (0.37 cm3 +/- 0.25 [standard deviation]) was significantly smaller than that in early group (0.56 cm3 +/- 0.39; P =.004, paired t test).

CONCLUSION

Absence of chondrocyte mound or presence of multilobed mound contour was associated with persistent reflux. Mean mound volume decreased over time. Treatment-induced hydroureteronephrosis was uncommon and self-limited.

摘要

目的

分析32例接受自体软骨细胞治疗膀胱输尿管反流的儿童肾脏集合系统、输尿管及膀胱的超声成像特征，并确定是否有任何特征与持续性反流相关。

材料与方法

将治疗后平均间隔1.4个月和12个月获得的超声图像与平均间隔2.7个月和12个月获得的膀胱造影图像进行比较。分析超声图像中软骨细胞丘的轮廓和体积、丘体积随时间的变化以及肾输尿管积水的情况。在14例有早期和晚期超声图像可供评估的患者中，采用配对t检验检测丘体积的平均差异。

结果

32例患者中有25例（56条治疗输尿管中的45条）可获得早期膀胱造影和超声图像。45条输尿管中有16条发生反流。在16条输尿管中，6条无软骨细胞丘，7条为单叶丘，3条为多叶丘。在29条无反流的治疗输尿管中，28条为单叶丘，1条为多叶丘。3例患者有轻度肾积水，1例有输尿管远端积水；这些情况均已缓解。22例患者中有18例（38条治疗输尿管中的30条）可获得晚期膀胱造影和超声图像。30条输尿管中有7条发生反流。在7条输尿管中，5条为单叶丘，2条为多叶丘。在23条无反流的治疗输尿管中，21条为单叶丘，2条为多叶丘。1例患者有轻度肾积水，已缓解。在14例有早期和晚期超声图像可供评估的患者中，晚期组的平均丘体积（0.37 cm³±0.25[标准差]）显著小于早期组（0.56 cm³±0.39；P = 0.004，配对t检验）。