Bayne Aaron P, Shoss Jeffrey M, Starke Nathan R, Cisek Lars J
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
J Laparoendosc Adv Surg Tech A. 2012 Jan-Feb;22(1):102-6. doi: 10.1089/lap.2011.0299. Epub 2011 Dec 13.
Minimally invasive approaches to the surgical management of vesicoureteric reflux (VUR) have become more prominent over the last 10 years with progress in both endoscopic and laparoscopic/robotic surgery. We hypothesized that laparoscopic extravesical detrussoraphy (LED) for the management of VUR in children with complex bladders and/or bilateral VUR was safe and effective.
Under institutional review board approval we evaluated the charts of all patients seen at our institution over the last 8 years who had undergone LED for the management of VUR. We evaluated demographic variables, surgical variables, and postoperative results. Postoperative bladder function was examined in the patients as well as need for secondary procedures. Patients with complex bladders included all patients who had previous surgery on the affected side, neurogenic bladders, and duplex or complex anatomy.
Ninety-eight patients with 144 ureters were treated during this time period. The overall VUR resolution by voiding cystourethrogram was 95.2%. The average age was 6.74 years, with 13 children over the age of 12 years old. Average length of stay (LOS) was 1.7 days for children 5 years and older and 1.0 days for children less than 5 years old (P=.004). LOS was not affected by body mass index or complexity of the procedure. There were 46 bilateral procedures, and the incidence of urinary retention was 6.5% versus 0% in the unilateral group (P=.09). Of our patients, 27.6% had complex bladders, including 9 patients with complete ureteral duplications, 10 with periureteral diverticula, and 8 with prior surgery on the affected side. There were two complications requiring a second procedure in this group (7%). No patient with a complex bladder had persistent VUR.
LED for the management of children with complex bladders and VUR is safe and effective. This technique is versatile and achieves high VUR resolution rates with minimal morbidity.
在过去10年中，随着内镜手术以及腹腔镜/机器人手术的进展，微创方法在膀胱输尿管反流（VUR）的外科治疗中变得更加突出。我们推测，腹腔镜膀胱外逼尿肌折叠术（LED）用于治疗合并复杂膀胱和/或双侧VUR的儿童VUR是安全有效的。
经机构审查委员会批准，我们评估了过去8年内在我院接受LED治疗VUR的所有患者的病历。我们评估了人口统计学变量、手术变量和术后结果。对患者的术后膀胱功能以及二次手术的需求进行了检查。复杂膀胱患者包括所有患侧曾接受过手术、神经源性膀胱以及重复或复杂解剖结构的患者。
在此期间，共治疗了98例患者的144条输尿管。通过排尿性膀胱尿道造影术，总体VUR治愈率为95.2%。平均年龄为6.74岁，其中有13名儿童超过12岁。5岁及以上儿童的平均住院时间（LOS）为1.7天，5岁以下儿童为1.0天（P = 0.004）。LOS不受体重指数或手术复杂性的影响。有46例双侧手术，尿潴留发生率在双侧组为6.5%，而单侧组为0%（P = 0.09）。在我们的患者中，27.6%患有复杂膀胱，其中包括9例完全性输尿管重复畸形患者、10例输尿管周围憩室患者和8例患侧曾接受过手术的患者。该组中有2例并发症需要二次手术（7%）。没有复杂膀胱患者存在持续性VUR。
LED用于治疗合并复杂膀胱和VUR的儿童是安全有效的。该技术用途广泛，能以最低的发病率实现高VUR治愈率。
