Chung Patrick Ho Yu, Lan Lawrence Cheun Leung, Wong Kenneth Kak Yuen, Tam Paul Kwong Hang
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Asian J Surg. 2009 Jul;32(3):163-6. doi: 10.1016/S1015-9584(09)60388-2.
Vesicoureteric reflux (VUR) is a common condition that may lead to end-staged renal failure. Treatment options include long term prophylactic antibiotics or surgical intervention. Recently, endoscopic treatment by a subureteral injection of Deflux has gained popularity. Our centre has introduced this treatment modality since 2002.
The medical records of 42 patients (15 male and 27 female) who received Deflux injections for treatment of VUR from 2002 to 2007 were reviewed. All the patients were followed up with voiding cystourethrograms at 3 months after the procedure.
The median age at operation was 72.59 months (range, 8 to 216 months). Unilateral involvement was found in 20 patients while 22 patients had bilateral involvement. Of the 64 ureters, VUR were grade II to V in six (9.4%), 31 (48.4%), 20 (31.2%) and seven (10.9%) patients respectively. Resolution of reflux, defined as grade 0 to I, after one injection was seen in six (100%), 20 (64.5%), and 16 (80%) ureters from grade II to IV respectively. Only one patient with grade V reflux achieved complete resolution after a single injection. Of the 21 ureters which had residual reflux, three were lost from follow up and 18 (ten grade III, two grade IV and six grade V) received a second injection and eventually 12 ureters achieved resolution. Thus, the overall success rate was 67.2% after a single injection and 85.9% after two injections. No procedure-related complications was reported.
Injections of Deflux is an effective treatment for VUR. A significant reduction in disease severity was seen in patients with grade II to IV disease after a single injection. Most patients with grade V disease needed more than one injection before achieving complete resolution. With this high success rate, we recommend the use of endoscopic Deflux injection as the first line treatment for children with vesicoureteric reflux disease.
膀胱输尿管反流（VUR）是一种常见病症，可能导致终末期肾衰竭。治疗选择包括长期预防性使用抗生素或手术干预。近来，通过输尿管下注射Deflux进行内镜治疗受到欢迎。自2002年起，我们中心引入了这种治疗方式。
回顾了2002年至2007年期间接受Deflux注射治疗VUR的42例患者（15例男性，27例女性）的病历。所有患者在术后3个月进行排尿性膀胱尿道造影随访。
手术时的中位年龄为72.59个月（范围8至216个月）。20例患者为单侧受累，22例患者为双侧受累。在64条输尿管中，反流程度为II至V级的患者分别有6例（9.4%）、31例（48.4%）、20例（31.2%）和7例（10.9%）。注射一次后，反流程度从II级至IV级分别有6条（100%）、20条（64.5%）和16条（80%）输尿管反流程度降至0至I级。仅1例V级反流患者单次注射后完全治愈。在21条有残余反流的输尿管中，3条失访，18条（10条III级、2条IV级和6条V级）接受了第二次注射，最终12条输尿管反流治愈。因此，单次注射后的总体成功率为67.2%，两次注射后的总体成功率为85.9%。未报告与手术相关的并发症。
注射Deflux是治疗VUR的有效方法。单次注射后，II至IV级疾病患者的疾病严重程度显著降低。大多数V级疾病患者在完全治愈前需要多次注射。鉴于如此高的成功率，我们建议将内镜下Deflux注射作为小儿膀胱输尿管反流疾病的一线治疗方法。
