Dore B, Irani J, Istin A, Bon D, Aubert J
Service d'Urologie, CHU de Poitiers.
J Urol (Paris). 1990;96(7):365-71.
On the basis of 133 cases, the authors analyse the clinical features and the modalities of the treatment of vesicorenal reflux in children under age 2. The number of girls is higher than that of boys. The diagnosis is most often established between 0 and 6 months of age, with a very marked peak between 0 and 1 month. The usual warning sign is a urinary infection with fever. Pyerography is normal in every second case, and retrograde cystography is the key examination, which confirms the reflux and establishes its side and degree (bilateral reflux in 53% of cases, stage II in 48% of cases). 33 children were operated at once. Another 100 first had a medical treatment, ie. urinary antibiotics, on the basis of strict criteria that are listed here. This medical treatment has been very disappointing: 20 children were lost to follow-up and 47 had secondary surgery. When surgery is necessary, advancing plasty according to Cohen's procedure yields excellent results: 98.6% of 76 operations were successful. The authors therefore think that Cohen's procedure is widely indicated, even in children under age 2.
基于133例病例,作者分析了2岁以下儿童膀胱输尿管反流的临床特征及治疗方式。女孩的数量多于男孩。诊断大多在0至6个月龄时确立,在0至1个月龄时有一个非常明显的高峰。常见的警示信号是伴有发热的泌尿系统感染。每两例中就有一例肾盂造影正常,逆行膀胱造影是关键检查,它能证实反流并确定其部位和程度(53%的病例为双侧反流,48%的病例为Ⅱ期)。33名儿童立即接受了手术。另外100名儿童首先接受了药物治疗,即使用尿路抗生素,治疗依据此处列出的严格标准进行。这种药物治疗效果非常令人失望:20名儿童失访,47名儿童接受了二次手术。当有必要进行手术时,按照科恩手术方法进行的推进式整形术取得了极佳的效果:76例手术中有98.6%成功。因此,作者认为科恩手术方法即使在2岁以下儿童中也广泛适用。