Nepple Kenneth G, Austin J Christopher, Hawtrey Charles E, Cooper Christopher S
Division of Pediatric Urology, University of Iowa, Iowa City, Iowa 52242, USA.
J Urol. 2005 Oct;174(4 Pt 2):1606-8. doi: 10.1097/01.ju.0000183882.09237.29.
In children with severe unilateral reflux nephropathy and diminished relative renal function (RRF) a dilemma exists between the choice of treatment with ureteral reimplantation or nephrectomy. Limited followup data are available regarding relative renal function or postoperative complications after ureteral reimplantation in kidneys with significant unilateral reflux nephropathy.
We retrospectively reviewed the records of 460 patients who underwent ureteral reimplantation between 1980 and 2002, and identified children with primary vesicoureteral reflux and severe unilateral reflux nephropathy (RRF 30% or less on renal scintigraphy). The postoperative outcomes were assessed for relative renal function and complications including hypertension, pyelonephritis or persistent reflux.
A total of 18 girls and 14 boys with a mean preoperative relative renal function of 20.1 +/- 7.8% (range 2% to 30%) met the inclusion criteria. Reflux grade in the poorly functioning kidney was II in 4 children (13%), III in 14 (44%), IV in 11 (34%) and V in 3 (9%). Reflux was unilateral in 15 children (47%) and bilateral in 17 (53%). Mean followup from surgery was 3.7 years (range 0.3 to 12.9). In 28 children with both preoperative and postoperative renal scans, mean preoperative RRF was 20.3 +/- 7.4% and mean postoperative RRF was 20.5 +/- 8.6% with a mean time between renal scans of 2.3 years. No statistically significant change was noted from preoperative to postoperative relative renal function with a mean change of +0.2 +/- 3.7% (range -6.5% to +10%, p=0.82). Postoperative complications occurred in 7 of the 32 children (22%), including hypertension (1), pyelonephritis (3) and persistent reflux (4). Pyelonephritis occurred in 1 child with persistent reflux. No statistically significant difference existed in mean preoperative relative renal function between those with and without complications (24.6 +/- 8.9% vs 18.8 +/- 7.2%, p = 0.09).
Children who underwent ureteral reimplantation in association with unilateral reflux nephropathy maintained stable relative renal function.
对于患有严重单侧反流性肾病且相对肾功能（RRF）降低的儿童，在选择输尿管再植术或肾切除术进行治疗时存在两难困境。关于单侧反流性肾病严重的肾脏进行输尿管再植术后的相对肾功能或术后并发症，现有的随访数据有限。
我们回顾性分析了1980年至2002年间接受输尿管再植术的460例患者的记录，并确定了患有原发性膀胱输尿管反流和严重单侧反流性肾病（肾闪烁显像显示RRF为30%或更低）的儿童。评估术后相对肾功能及并发症，包括高血压、肾盂肾炎或持续性反流的情况。
共有18名女孩和14名男孩符合纳入标准，术前平均相对肾功能为20.1±7.8%（范围为2%至30%）。肾功能不佳的肾脏反流分级为II级的有4名儿童（13%），III级的有14名（44%），IV级的有11名（34%），V级的有3名（9%）。反流为单侧的有15名儿童（47%），双侧的有17名（53%）。手术平均随访时间为3.7年（范围为0.3至12.9年）。在28名术前后均进行肾脏扫描的儿童中，术前平均RRF为20.3±7.4%，术后平均RRF为20.5±8.6%，肾脏扫描的平均间隔时间为2.3年。术前至术后相对肾功能无统计学显著变化，平均变化为+0.2±3.7%（范围为-6.5%至+10%，p=0.82）。32名儿童中有7名（22%）发生术后并发症，包括高血压（1例）、肾盂肾炎（3例）和持续性反流（4例）。1例持续性反流儿童发生肾盂肾炎。有并发症和无并发症儿童术前平均相对肾功能无统计学显著差异（24.6±8.9%对18.8±7.2%，p = 0.09）。
接受输尿管再植术合并单侧反流性肾病的儿童相对肾功能保持稳定。
