Seseke F, Strauss A, Seseke S, Zappel H, Ringert R H, Zöller G
Klinik für Urologie, Georg-August-Universität, Robert-Koch-Strasse 40, 37075 Göttingen.
Urologe A. 2006 Jul;45(7):852-7. doi: 10.1007/s00120-006-1051-5.
In bilateral VUR, Cohen cross-trigonal ureteric reimplantation is a popular but also controversial surgical approach. We present our own experience in a retrospective analysis.
Between 1990 and 2005, 41 children (26 girls, 15 boys) with bilateral reflux [92 renal units (RU)] underwent ureteric reimplantation. The mean age was 4.5 (0.3-12) years. Eight patients had ureteral duplication (six unilateral, two bilateral); 12 of 41 patients had no intraoperative ureteral stenting. Seven patients had prior surgery for VUR. A successful result was defined as absence of VUR, significant UVJ obstruction, or voiding dysfunction throughout the follow-up.
The mean follow-up was 7.8 (0.5-15) years. Eight patients (19.5%) had 13 complications. One patient had an intraoperative small bowel lesion (2%). Six patients (14.6%) had UTI. Four patients (9.8%) showed transient UVJ obstruction. Three required a temporary percutaneous nephrostomy. Two of these patients had no intraoperative ureteral stenting. Recurrence of VUR was found in 2 patients (4.8%) and 2/92 RU (2.2%), respectively. Complications were more frequent in high-grade VUR, ureter duplex, or unstented ureteral reimplantation. Prior surgery for VUR did not influence the postoperative outcome. Postoperative voiding disorders were not observed.
Two unilateral recurrences of VUR were observed, requiring a reoperation in one patient. A reoperation for UVJ obstruction was not necessary. Related to 92 RU the surgical success rate was 97.8%. Intraoperative ureteral stenting has to be considered with respect to the current discussion of shortening inpatient procedures. In our experience, the perioperative risk was elevated in patients with high-grade VUR or ureteral duplication.
在双侧膀胱输尿管反流（VUR）中，科恩（Cohen）经三角区输尿管再植术是一种常用但也存在争议的手术方法。我们通过回顾性分析介绍我们自己的经验。
1990年至2005年间，41例双侧反流患儿（26例女孩，15例男孩，共92个肾单位[RU]）接受了输尿管再植术。平均年龄为4.5（0.3 - 12）岁。8例患者存在输尿管重复畸形（6例单侧，2例双侧）；41例患者中有12例术中未放置输尿管支架。7例患者曾因VUR接受过手术。成功的结果定义为在整个随访期间无VUR、明显的膀胱输尿管连接部（UVJ）梗阻或排尿功能障碍。
平均随访时间为7.8（0.5 - 15）年。8例患者（19.5%）出现了13种并发症。1例患者术中出现小肠损伤（2%）。6例患者（14.6%）发生尿路感染（UTI）。4例患者（9.8%）出现短暂性UVJ梗阻。3例患者需要临时经皮肾造瘘术。其中2例患者术中未放置输尿管支架。分别在2例患者（4.8%）和2/92个肾单位（2.2%）中发现VUR复发。高级别VUR、输尿管重复畸形或未放置支架的输尿管再植术中并发症更为常见。既往因VUR接受的手术对术后结果无影响。未观察到术后排尿障碍。
观察到2例VUR单侧复发，其中1例患者需要再次手术。无需因UVJ梗阻进行再次手术。相对于92个肾单位，手术成功率为97.8%。鉴于当前关于缩短住院时间的讨论，术中输尿管支架置入术必须予以考虑。根据我们的经验，高级别VUR或输尿管重复畸形患者围手术期风险升高。
