成人人群中膀胱输尿管反流的内镜治疗：我们能否教我们的成人泌尿科同事？
Endoscopic treatment of vesicoureteral reflux in an adult population: Can we teach our adult urology colleagues?
机构信息
Division of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel.
出版信息
J Pediatr Urol. 2010 Dec;6(6):600-4. doi: 10.1016/j.jpurol.2010.01.012. Epub 2010 Mar 2.
OBJECTIVE
Vesicoureteral reflux (VUR) is not well described or understood in adults. Since endoscopic correction of VUR has become a first-line therapy in children, we aimed to evaluate the efficacy of this technique in adult patients.
PATIENTS AND METHODS
In 1988-2008, 49 adult patients (6 males, 43 females) with a mean age of 33.6 years (range 18-64) underwent endoscopic treatment of VUR. Reflux was unilateral in 17 (34.7%) and bilateral in 32 (65.3%) patients, comprising 81 renal refluxing units (RRU). Of these, 71 (87.7%) were primary VUR. Reflux was Grade I in 14 (17%), Grade II in 46 (56.8%), Grade III in 17 (21%) and Grade IV in 4 (4.9%) RRU. Median renal function at surgery was 41.2%. Endoscopic correction utilized polytetrafluoroethylene (Teflon) in 38 (77.6%) and dextranomer/hyaluronic acid copolymer in 11 (22.4%) patients. Recurrent febrile urinary tract infection (UTI) was the only indication for surgery. Grade I VUR was treated only in patients with contralateral high-grade VUR.
RESULTS
The reflux was corrected in 63 (77.8%) RRU after a single injection, after second injection in 9 (10.6%) and after third in 4 (4.8%) RRU. In 3 (3.5%) RRU, VUR improved to Grade I. In 2 (2.4%), endoscopic correction failed, leading to open reimplantation. One patient with corrected VUR underwent nephrectomy due to non-functioning kidney and recurrent pyelonephritis. Fourteen (28.6%) patients suffered afebrile UTI. Five (10.2%) developed febrile UTI following successful endoscopic correction, leading to a diagnosis of VUR recurrence in two (4.1%) patients.
CONCLUSIONS
Endoscopic correction of VUR in adults is a simple and effective procedure, as in pediatric practice.
目的
在成人中，膀胱输尿管反流（VUR）的描述和理解并不完善。由于内镜下矫正 VUR 已成为儿童的一线治疗方法，我们旨在评估该技术在成年患者中的疗效。
患者和方法
1988 年至 2008 年，49 例平均年龄为 33.6 岁（18-64 岁）的成年患者（6 名男性，43 名女性）接受了内镜治疗 VUR。反流单侧 17 例（34.7%），双侧 32 例（65.3%），共 81 个肾反流单位（RRU）。其中，71 例（87.7%）为原发性 VUR。RRU 中，Ⅰ级 14 例（17%），Ⅱ级 46 例（56.8%），Ⅲ级 17 例（21%），Ⅳ级 4 例（4.9%）。手术时中位肾功能为 41.2%。38 例（77.6%）采用聚四氟乙烯（特氟隆），11 例（22.4%）采用葡聚糖/透明质酸共聚物进行内镜矫正。复发性发热性尿路感染（UTI）是手术的唯一指征。仅对有对侧高级别 VUR 的患者治疗Ⅰ级 VUR。
结果
单次注射后，63 个（77.8%）RRU 的反流得到纠正，9 个（10.6%）RRU 需二次注射，4 个（4.8%）RRU 需三次注射。3 个（3.5%）RRU 的 VUR 改善至Ⅰ级。2 个（2.4%）内镜矫正失败，导致开放再植入。1 例 VUR 矫正患者因肾功能衰竭和复发性肾盂肾炎行肾切除术。14 例（28.6%）患者发生无热 UTI。5 例（10.2%）在成功内镜矫正后发生发热性 UTI，导致 2 例（4.1%）患者诊断为 VUR 复发。
结论
与儿科实践一样，成人 VUR 的内镜矫正也是一种简单有效的方法。
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