Wadie George M, Tirabassi Michael V, Courtney Richard A, Moriarty Kevin P
Department of Pediatric Surgery, Baystate Children's Hospital, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
J Laparoendosc Adv Surg Tech A. 2007 Jun;17(3):353-9. doi: 10.1089/lap.2006.0073.
The aim of this study was to review the experience of a single institution with the Deflux (Q-Med Scandinavia; Uppsala, Sweden) procedure and assess its effectiveness in reducing the incidence of urinary tract infections (UTIs) in children with vesicoureteric reflux (VUR).
After institutional review board approval, the charts of 100 patients with VUR, who presented between June 2003 and June 2005, were prospectively reviewed. Data collected included: demographics, the number of preoperative and postoperative UTIs, a radiologic grade of VUR on a voiding cystourethrogram (VCUG) and the presence of VUR on a radionuclide VCUG 3 months after the procedure. Patients were continued on oral antibiotics until urine culture at 3 months was negative and no reflux was demonstrated on VCUG. The student's t test was used for data analysis.
The mean age was 3.8 +/- 0.3 years, and 76% were girls. From 155 ureters treated, 10 had Grade I reflux, 42 Grade II, 76 Grade III, 25 Grade IV, and 2 Grade V. A second injection was required in 22 ureters (14.2%). The overall success rate of the procedure (Grade 0 reflux at 3 months) was 77.4% after the first injection and 83.9% after a second injection. The success rate per grade was: 100% for Grade I, 88.1% for Grade II, 86.8% for Grade III, 64% for Grade IV, and 50% for Grade V. The mean follow-up was 446 +/- 20 days. The mean volume injected/ureter was 0.6 +/- 0.03 mL. Thirteen (13) patients had UTIs after the procedure, compared to 75 before. There was a 5-fold reduction in the incidence of UTIs/year, from a mean of 0.68 +/- 0.09 pre- to 0.12 +/- 0.04 postinjection (P = 0.001). The majority of UTIs were caused by Escherichia coli (74% pre- and 82% postinjection).
We conclude that the Deflux procedure is effective not only in eliminating VUR on radiologic studies, but also in reducing the incidence of UTIs and antibiotic use in children with VUR.
本研究旨在回顾一家机构应用Deflux（瑞典乌普萨拉市Q-Med斯堪的纳维亚公司）治疗的经验，并评估其在降低膀胱输尿管反流（VUR）患儿尿路感染（UTI）发生率方面的有效性。
经机构审查委员会批准，对2003年6月至2005年6月期间就诊的100例VUR患儿的病历进行前瞻性回顾。收集的数据包括：人口统计学资料、术前和术后UTI的次数、排尿性膀胱尿道造影（VCUG）上VUR的放射学分级以及术后3个月放射性核素VCUG上VUR的存在情况。患者持续口服抗生素，直至3个月时尿培养阴性且VCUG未显示反流。采用学生t检验进行数据分析。
平均年龄为3.8±0.3岁，76%为女孩。在接受治疗的155条输尿管中，10条为I级反流，42条为II级，76条为III级，25条为IV级，2条为V级。22条输尿管（14.2%）需要进行第二次注射。首次注射后该治疗的总体成功率（术后3个月0级反流）为77.4%，第二次注射后为83.9%。各分级的成功率分别为：I级100%，II级88.1%，III级86.8%，IV级64%，V级50%。平均随访时间为446±20天。每条输尿管的平均注射量为0.6±0.03 mL。术后有13例患者发生UTI，术前为75例。UTI的年发生率降低了5倍，从注射前的平均0.68±0.09降至注射后的0.12±0.04（P = 0.001）。大多数UTI由大肠杆菌引起（注射前74%，注射后82%）。
我们得出结论，Deflux治疗不仅在放射学检查中有效消除VUR，而且在降低VUR患儿UTI的发生率和抗生素使用方面也有效。
