Department of Renal Transplant, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK.
J Pediatr Urol. 2012 Feb;8(1):97-102. doi: 10.1016/j.jpurol.2010.10.001. Epub 2010 Nov 5.
We present the initial clinical results of the 'modified Barry technique' for the prevention of VUR in paediatric renal transplant grafts. Ours is the only centre in the UK using this technique, as confirmed in a questionnaire developed in our department.
We retrospectively analysed data of 15 paediatric renal transplant patients (operated June 2006-November 2009) who had their vesicoureteric anastomosis performed using the modified Barry technique with a 2-cm submucosal anti-reflux tunnel. The original Barry technique involved the creation of a 4-cm tunnel; this was modified by us to reduce the risk of ureteric stenosis.
At a median follow up of 23.7 months (6.3-39.4), the incidence of VUR was 7% (1/15). There was no evidence of postoperative urological complications, such as urinary leak, primary ureteric obstruction including anastomotic stricture/stenosis, transplant graft renal calculi and chronic rejection. At current follow up, graft and patient survival are 100%.
With the introduction of the modified Barry technique, the incidence of VUR in our series fell 10-fold to 7%, compared with our earlier study (P<0.0001), without any urological complications. Although the initial results are encouraging, larger patient numbers and longer follow up are required to validate this technique further.
我们介绍了“改良 Barry 技术”在儿科肾移植移植物中预防 VUR 的初步临床结果。我们是英国唯一使用该技术的中心，这在我们部门制定的问卷中得到了证实。
我们回顾性分析了 2006 年 6 月至 2009 年 11 月期间使用改良 Barry 技术进行膀胱输尿管吻合术的 15 例儿科肾移植患者的数据，该技术采用了 2cm 黏膜下抗反流隧道。原始的 Barry 技术涉及创建一个 4cm 的隧道；我们对其进行了修改，以降低输尿管狭窄的风险。
在中位数为 23.7 个月（6.3-39.4）的随访中，VUR 的发生率为 7%（1/15）。没有术后泌尿道并发症的证据，如尿漏、原发性输尿管梗阻（包括吻合口狭窄/梗阻）、移植肾结石和慢性排斥反应。在目前的随访中，移植物和患者的存活率均为 100%。
通过引入改良 Barry 技术，我们的系列中 VUR 的发生率从我们早期的研究下降了 10 倍，降至 7%（P<0.0001），而没有任何泌尿道并发症。尽管初步结果令人鼓舞，但需要更大的患者数量和更长的随访时间来进一步验证该技术。
