Lacreuse Isabelle, Moog Raphael, Kadoch Vanessa, Fischbach Michel, Merol Marile-Laurence Poli, Becmeur François
University Hospital of Strasbourg, Strasbourg, France.
Pediatr Rep. 2009 Jun 8;1(1):e7. doi: 10.4081/pr.2009.e7.
No bulking agent is ideal for endoscopically treating vesico-renal reflux in children. Many teams have tried to find a safe and efficient material, ideally an autologous material. We describe here a protocol for the use of autologous viable fat in the treatment of primary vesico-renal reflux in children aged from 3 to 15 years. Fat harvesting was done from the medial side of the thigh by manual aspiration. Samples were centrifuged to purify the graft from blood and lipid. Lastly fat was injected beneath the pathologic ureter by a conventional endoscopic technique. A voiding cystourethrography (VCUG) closed the procedure. Follow-up included renal ultrasonography the day after surgery, and one and three months later. A VCUG was performed systematically at three months and, in cases of acute pyelonephritis, during the survey.Sixty-four children with 94 refluxing units were treated by autologous fat injection with a follow-up from 6 to 40 months. At the end of the procedure, we systematically obtained a very good increase in height of the pathologic meatus and VCUG was normal in all cases. None presented with an obstruction during the follow-up period. Two children presented with an acute pyelonephritis before the third month. At three months, VCUG was not realized in 14 cases (22%) because the parents refused the procedure. One of those children presented with an acute pyelonephritis five months after endoscopic treatment. VCUG was normal for 17 of 50 children (34%), and showed a real improvement for 19 other children (38%). Three children had a surgical reimplantation because of the persistence of an unchanged high-grade vesico-renal reflux; histological examination found viable adipocytes on sections of the distal pathologic ureter. Clinically, 11 children (17%) presented with an acute pyelonephritis after treatment at a mean follow-up time of 10 months.These preliminary findings led us to modify the technique in order to improve our results. Our first concern is feasibility and safety of this technique, regardless of the use of other synthetic bulking agents the innocuousness of which is uncertain.
没有一种填充剂对于儿童膀胱输尿管反流的内镜治疗是理想的。许多团队都试图找到一种安全有效的材料，理想的是自体材料。我们在此描述一种使用自体活性脂肪治疗3至15岁儿童原发性膀胱输尿管反流的方案。通过手动抽吸从大腿内侧获取脂肪。样本经过离心以从血液和脂质中纯化移植物。最后，通过传统的内镜技术将脂肪注射到病变输尿管下方。排尿性膀胱尿道造影（VCUG）结束该操作。随访包括术后第一天、术后1个月和3个月的肾脏超声检查。在3个月时系统地进行一次VCUG，对于急性肾盂肾炎的病例，在随访期间进行检查。64例患有94个反流单位的儿童接受了自体脂肪注射治疗，随访时间为6至40个月。在操作结束时，我们系统地观察到病变尿道口高度有非常明显的增加，并且所有病例的VCUG均正常。在随访期间没有一例出现梗阻。2例儿童在第三个月前出现急性肾盂肾炎。在3个月时，14例（22%）儿童未进行VCUG，因为家长拒绝该操作。其中1例儿童在内镜治疗5个月后出现急性肾盂肾炎。50例儿童中有17例（34%）的VCUG正常，另外19例（38%）显示有实际改善。3例儿童因持续存在未改变的重度膀胱输尿管反流而接受了手术再植；组织学检查在病变输尿管远端切片上发现了存活的脂肪细胞。临床上，11例儿童（17%）在平均随访10个月后治疗后出现急性肾盂肾炎。这些初步结果促使我们改进技术以提高疗效。我们首要关注的是该技术的可行性和安全性，而不考虑使用其他合成填充剂，其安全性尚不确定。
