Calisti A, Perrotta M L, Coletta R, Olivieri C, Briganti V, Oriolo L, Fabbri R
Pediatric Surgery and Urology Unit, San Camillo Hospital, Circ. Gianicolense 87, 00152 Rome, Italy.
Int J Pediatr. 2011;2011:103067. doi: 10.1155/2011/103067. Epub 2011 Dec 14.
Purpose. Totally endoscopic management (all-endo) of patients with a duplicated renal system (DS) associated with severe vesicoureteral reflux (VUR) or obstructive ureterocele (UC) is an attractive alternative to traditional open procedures. The authors discuss feasibility and results of an all-endo approach on a consecutive series of patients. Methods. From 1999 to 2009, all patients with a complete DS associated with UC and/or VUR were proposed for primary all-endo approach. UC puncture was performed using a 3 Fr Bugbee electrode. Deflux (dextranomer/hyaluronic acid copolymer) injection was administered for VUR. The need for secondary surgery was evaluated on followup. Results. Of the 62 patients recruited, 46 were treated using a primary all-endo approach and 16 patients received no treatment. Of the 46 treated patients with 56 affected renal units, 32 (97%) UCs collapsed following puncture and 29 (63%) VURs were resolved or downgraded. Secondary VUR occurred in 13 (39%) renal units. Secondary surgery was performed on 23 (41%) renal units. Conclusion. The all-endo approach for VUR in DS is an effective therapeutic option. UC collapse was achieved by puncture in most of the patients; secondary VUR was the main complication in a small group of extravesical UC.
目的。对于合并严重膀胱输尿管反流（VUR）或梗阻性输尿管囊肿（UC）的重复肾系统（DS）患者，全内镜治疗（全内镜法）是传统开放手术颇具吸引力的替代方案。作者探讨了对一系列连续患者采用全内镜法的可行性及结果。方法。1999年至2009年，所有合并UC和/或VUR的完整DS患者均被建议采用初次全内镜法。使用3Fr Bugbee电极进行UC穿刺。对于VUR，给予Deflux（葡聚糖omer/透明质酸共聚物）注射。随访时评估二次手术的必要性。结果。在招募的62例患者中，46例采用初次全内镜法治疗，16例患者未接受治疗。在46例接受治疗的患者中，56个患肾单位中，32个（97%）UC在穿刺后塌陷，29个（63%）VUR得到解决或分级降低。13个（39%）肾单位出现继发性VUR。23个（41%）肾单位接受了二次手术。结论。DS中VUR的全内镜法是一种有效的治疗选择。大多数患者通过穿刺实现了UC塌陷；继发性VUR是一小部分膀胱外UC的主要并发症。
