Leonard Michael P
Departments of Surgery and Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario.
Paediatr Child Health. 2002 Oct;7(8):545-50. doi: 10.1093/pch/7.8.545.
To review the application and outcome of endoscopic injection therapy for vesicoureteric reflux in regard to its evolution over the past two decades.
Review articles, original reports and abstracts pertaining to endoscopic injection therapy were obtained through a PubMed search of English, German and French publications from 1981 to 2001.
A total of 46 studies were selected. Four were selected to support basic concepts in the management of vesicoureteric reflux, and the remainder pertained specifically to endoscopic injection therapy for vesicoureteric reflux.
The reports were analyzed with focus on the physical properties of the biomaterial injected, results of treatment in regard to the cure of vesicoureteric reflux, duration of cure, and possible adverse effects and clinical benefits engendered by the use of injectable materials.
Endoscopic injection therapy successfully cures vesicoureteric reflux in 60% to 80% of cases. Success rates are higher with particulate materials (Teflon and Macroplastique) than with bovine collagen or autologous chondrocytes. Long term data regarding cure are scant. Although concerns about particulate migration and autoimmune disease exist, these have not been borne out of clinical experience. Endoscopic injection may be accomplished on an outpatient basis, with less morbidity than with open ureteroneocystostomy.
Endoscopic injection therapy should be offered as an alternative treatment in patients with indications to consider ureteroneocystotomy, but should not change the indications for surgical intervention. The ideal biomaterial for injection has yet to be developed, but the field of autologous tissue engineering holds promise for future development.
回顾过去二十年内镜注射治疗膀胱输尿管反流的应用情况及治疗效果。
通过检索1981年至2001年期间发表的英文、德文和法文文献，从PubMed获取有关内镜注射治疗的综述文章、原始报告及摘要。
共选取46项研究。其中4项用于支持膀胱输尿管反流治疗的基本概念，其余研究专门针对膀胱输尿管反流的内镜注射治疗。
分析这些报告，重点关注所注射生物材料的物理特性、膀胱输尿管反流治愈情况、治愈持续时间以及使用可注射材料可能产生的不良反应和临床益处。
内镜注射治疗在60%至80%的病例中成功治愈膀胱输尿管反流。颗粒材料（聚四氟乙烯和Macroplastique）的成功率高于牛胶原蛋白或自体软骨细胞。关于治愈的长期数据较少。尽管存在对颗粒迁移和自身免疫性疾病的担忧，但临床经验并未证实这些担忧。内镜注射可在门诊进行，与开放性输尿管膀胱吻合术相比，发病率更低。
对于有指征考虑输尿管膀胱吻合术的患者，应提供内镜注射治疗作为替代治疗方法，但不应改变手术干预的指征。理想的注射用生物材料尚未开发出来，但自体组织工程领域有望在未来取得发展。
