Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.
J Pediatr Urol. 2013 Oct;9(5):665-9. doi: 10.1016/j.jpurol.2012.07.021. Epub 2012 Aug 17.
To report our experience of open ureteroneocystostomy after failed endoscopic treatment.
Clinical charts of 787 children who entered our dextranomer/hyaluronic acid copolymer (DxHA) endoscopic injection program for vesicoureteral reflux (VUR) treatment between May 2000 and December 2009 were reviewed. Fifty-one of these patients were submitted to open ureteroneocystostomy for complete resolution of VUR.
Twenty-eight patients (55%) were female. Median age at surgery was 65 months (range: 26-182). Median time going from first endoscopic injection until open surgery was 13 months (range 1-58). Surgical ureteral reimplantation was bilateral in 62.7% of the cases. Of a total of 83 operated ureters, nine were duplex ureters, nine were megaureters, six were ectopic, and two had periureteral diverticulum. Mean operative time was 70 min (range 45-120 min). There were no intra-operative complications. Follow-up VCUG showed complete resolution of VUR in 98% of patients. There was only one right-sided grade III VUR that persisted after bilateral reimplantation. It resolved with a single subureteral DxHA injection.
Ureteroneocystostomy after a failed endoscopic treatment can achieve successful results in a high percentage of patients with minimal complications.
报告我们在腔内治疗失败后行开放输尿-肾盂成形术的经验。
回顾 2000 年 5 月至 2009 年 12 月期间，787 例儿童接受聚葡糖/透明质酸钠（DxHA）腔内注射治疗膀胱输尿管反流（VUR）的临床资料。其中 51 例患儿因 VUR 完全缓解而行开放输尿-肾盂成形术。
28 例（55%）为女性。手术时中位年龄为 65 个月（范围：26-182）。从首次腔内注射到开放手术的中位时间为 13 个月（范围 1-58）。62.7%的病例行双侧输尿管再植术。83 个手术输尿管中，9 个为双输尿管，9 个为巨输尿管，6 个为异位输尿管，2 个有输尿管旁憩室。平均手术时间为 70 分钟（范围 45-120 分钟）。无术中并发症。术后 VCUG 显示 98%的患者 VUR 完全缓解。仅 1 例双侧再植术后出现右侧 III 级 VUR，经单次输尿管下 DxHA 注射后缓解。
腔内治疗失败后行输尿-肾盂成形术可使大部分患者获得成功，且并发症少。
