Smellie J M, Tamminen-Möbius T, Olbing H, Claesson I, Wikstad I, Jodal U, Seppänen U
University Children's Hospital, Essen, FRG.
Pediatr Nephrol. 1992 May;6(3):223-30. doi: 10.1007/BF00878353.
The renal findings on intravenous urography (IVU) are reported in 306 children (73 boys, 233 girls) from eight European centres entered into an international study comparing medical and surgical management of children with urinary tract infection and severe vesico-ureteric reflux followed for 5 years. One hundred and fifty-five children were randomly allocated to medical and 151 to surgical treatment. Protocol and investigative techniques were standardised and randomisation, data collection and analysis were performed centrally in Essen, Germany. At entry 149 (49%) has established renal scarring (79 medical, 70 surgical). Children with normal kidneys (105), areas of thinned parenchyma (52) and grade of reflux were also evenly distributed. IVU was repeated at 6, 18 and 54 months and serial urine culture, 99mtechnetium-dimercaptosuccinic acid scans and plasma creatinine estimations were performed. Two hundred and seventy-two children (89%) completed this follow-up. In 174 children (57%), (90 medical, 84 surgical) there was renal growth without morphological change. New renal scars developed in 19 children treated medically and 20 surgically; 12 (5 medical, 7 surgical) developed in previously normal kidneys. Six followed post-operative obstruction. No significant difference in outcome was found between medical or surgical management in terms of the development of new renal lesions or the progression of established renal scars.
在一项国际研究中，对来自八个欧洲中心的306名儿童（73名男孩，233名女孩）静脉尿路造影（IVU）的肾脏检查结果进行了报告。该研究比较了药物治疗和手术治疗对患有尿路感染和严重膀胱输尿管反流儿童的疗效，随访时间为5年。155名儿童被随机分配接受药物治疗，151名接受手术治疗。研究方案和检查技术进行了标准化，随机分组、数据收集和分析在德国埃森集中进行。入组时，149名（49%）儿童已出现肾脏瘢痕形成（79名接受药物治疗，70名接受手术治疗）。肾脏正常的儿童（105名）、肾实质变薄区域（52名）以及反流分级也分布均匀。在6个月、18个月和54个月时重复进行IVU检查，并进行系列尿培养、锝-二巯基丁二酸扫描和血浆肌酐测定。272名儿童（89%）完成了此次随访。174名儿童（57%）（90名接受药物治疗，84名接受手术治疗）肾脏有生长但无形态改变。接受药物治疗的19名儿童和接受手术治疗的20名儿童出现了新的肾脏瘢痕；其中12名（5名接受药物治疗，7名接受手术治疗）出现在之前肾脏正常的儿童中。6名出现术后梗阻。在新肾脏病变的发生或已形成肾脏瘢痕的进展方面，药物治疗和手术治疗的结果没有显著差异。
