Dodat H, Takvorian P
Service de Chirurgie Pédiatrique, Hôpital Edouard-Herriot, Lyon.
Ann Chir. 1990;44(10):824-9.
Endoscopic injection of teflon paste, used since 1984, represents an alternative to the surgical treatment of vesico-renal reflux. The success rate varies from 75 to 89% after a single injection and from 85 to 95% after two injections, according to the teams. The results are less satisfactory for the high grades and for refluxes on duplicity (25 to 45% failure rate). This technique is particularly attractive in the case of a difficult surgical intervention, notably when a reimplantation has failed, in the case of reflux on neurological bladder, urethral valves or exstrophy. Various causes of failure or relapse are considered. The advantages of the technique are obvious (low morbidity, very short hospital stay) and surgery is always possible in the case of failure. After one or two years, the reflux reappears in 2 to 9% cases. Long term results cannot be assessed as the follow-up period is too brief at the present time. For this reason, and although the endoscopic and surgical findings are reassuring, tolerance to teflon both locally and at a distance requires confirmation and other products such as collagen are now being used.
自1984年起使用的内镜下注射聚四氟乙烯糊剂,是膀胱-肾反流手术治疗的一种替代方法。根据不同团队的研究,单次注射后的成功率在75%至89%之间,两次注射后的成功率在85%至95%之间。对于高级别反流和重复反流,结果不太令人满意(失败率为25%至45%)。在手术干预困难的情况下,尤其是再植失败、神经源性膀胱反流、尿道瓣膜或膀胱外翻的情况下,该技术特别有吸引力。人们考虑了各种失败或复发的原因。该技术的优点显而易见(发病率低、住院时间极短),而且在失败的情况下总是可以进行手术。一两年后,2%至9%的病例会再次出现反流。由于目前随访期太短,无法评估长期结果。因此,尽管内镜检查和手术结果令人放心,但聚四氟乙烯在局部和远处的耐受性仍需证实,现在正在使用其他产品,如胶原蛋白。