Laurenti C, De Dominicis C, Iori F, Dal Forno S, Franco G, Minardi V, Roccheggiani A
Chaire d'Urologie Pédiatrique, Université de Rome La Sapienza, Italie.
J Urol (Paris). 1989;95(4):213-6.
The need of bilateral reimplantation in unilateral reflux is still stressed by some authors. The following represents the rationale for this surgical management. 1. correction of unilateral reflux may increase bladder pressure and in this way induce a contralateral reflux; 2. the operation on one side may lead to changes in the muscles and cause reflux on the opposite one; 3. reflux, though unilateral, is the result of a malformation involving the whole trigone. Nevertheless, the authors regard as unjustified the reimplantation of a normal ureterovesical junction being in-acceptable the risk, even if low, of operative failure on a ureter without reflux. Literature data show an incidence of contralateral reflux after unilateral reimplantation of 11-32%. Such incidence, however, tends to decrease (1.9-20%) one year after the operation due to the spontaneous resolution of reflux in most of the cases. The grade of reflux was low (I-II grade) in the majority of cases. The authors report on 38 cases of unilateral primitive vesico-ureteral reflux who underwent unilateral ureteral reimplantation between 1981 and 1982. Minimum follow-up was 2 years. After surgery, contralateral reflux occurred in 4 cases (10.5%) but it spontaneously subsided within 3 years in all of them. Contralateral reflux was asymptomatic in 3 cases and in no cases caused renal scars. The authors conclude that unilateral ureteral reimplantation is the procedure of choice in children with unilateral reflux. Bilateral reimplantation, however, will be performed in patients with bilateral reflux who showed disappearance of reflux on one side before the operation.
一些作者仍然强调单侧反流时双侧再植术的必要性。以下是这种手术治疗的理论依据。1. 纠正单侧反流可能会增加膀胱压力，从而诱发对侧反流；2. 一侧的手术可能会导致肌肉变化，进而引起对侧反流；3. 反流虽然是单侧的，但却是涉及整个三角区的畸形结果。然而，作者认为对正常输尿管膀胱连接部进行再植术是不合理的，因为即使手术失败的风险很低，对于无反流的输尿管来说也是不可接受的。文献数据显示，单侧再植术后对侧反流的发生率为11% - 32%。然而，由于大多数病例中的反流会自发缓解，这种发生率在术后一年往往会降低（1.9% - 20%）。大多数病例的反流程度较低（I - II级）。作者报告了1981年至1982年间接受单侧输尿管再植术的38例单侧原发性膀胱输尿管反流病例。最短随访时间为2年。术后，4例（10.5%）出现对侧反流，但所有病例在3年内均自发消退。3例对侧反流无症状，无一例导致肾瘢痕形成。作者得出结论，单侧输尿管再植术是单侧反流患儿的首选治疗方法。然而，对于术前一侧反流已消失的双侧反流患者，将进行双侧再植术。
