Inugala Anusiri, Reddy Ramesh Kota, Rao Bhuvaneshwar Nadipalli, Reddy Sreenivas P, Othuluru Radhika, Kanniyan Lavanya, Kumbha Nagarjuna, Srirampur Srinivas
Department of Pediatric Surgery, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India.
Department of Pathology, Niloufer Institute of Women and Child Health, Hyderabad, Telangana, India.
J Indian Assoc Pediatr Surg. 2017 Jul-Sep;22(3):129-133. doi: 10.4103/jiaps.JIAPS_254_16.
To investigate the correlation between the status of interstitial cells of Cajal (ICC) in ureteropelvic junction (UPJ) and the resected ureteric margin and the postoperative outcome of Anderson-Hynes pyeloplasty in UPJ obstruction (UPJO) and to compare the ICC in the UPJ and the resected margin of the normal ureter.
An observational study was conducted over a period of 2 years at the Department of Pediatric Surgery at Niloufer Institute of Women and Child Health. Children with intrinsic UPJO who underwent Anderson-Hynes dismembered pyeloplasty were included in the study. Six months postoperatively, the patients were divided into two groups based on diuretic isotopic renogram using technetium-99m-labeled diethylene triaminepentaacetic acid. Group 1 comprised patients with good surgical outcome. Group 2 comprised patients with a poor outcome. The histologic specimens were evaluated for ICC, and the immunohistochemical findings were correlated with the outcome.
Twenty-five patients were included in this study (19 male and 6 female). Seventy-six percent of patients were under the age of 1 year. Group 1 had 23 cases and Group 2 had 2 cases. Out of the two patients with a poor outcome, one had negative grading at the UPJ and one had positive grading. Both these patients had a negative grading at the lower resected margins. More number of patients (24%) had +++ grading at the lower resected margin when compared to the UPJ (8%).
This is the first study which correlates the status of ICC in UPJ with the outcome of pyeloplasty in pediatric patients. Both the cases with bad outcome had no ICC at the lower margin of the resected specimen and one case had no ICC at the UPJ. There is a statistically significant difference ( = 0.001) in the number of ICC at the UPJ and the resected margin.
探讨输尿管肾盂连接部（UPJ）中Cajal间质细胞（ICC）状态与切除的输尿管切缘以及UPJ梗阻（UPJO）患者Anderson-Hynes肾盂成形术术后结果之间的相关性，并比较UPJ和正常输尿管切除切缘中的ICC。
在尼鲁弗妇女儿童医院小儿外科进行了为期2年的观察性研究。纳入接受Anderson-Hynes离断性肾盂成形术的原发性UPJO患儿。术后6个月，根据使用锝-99m标记的二乙三胺五乙酸的利尿同位素肾图将患者分为两组。第1组包括手术结果良好的患者。第2组包括结果较差的患者。对组织学标本进行ICC评估，并将免疫组化结果与结果相关联。
本研究纳入25例患者（19例男性和6例女性）。76%的患者年龄在1岁以下。第1组有23例，第2组有2例。在结果较差的2例患者中，1例在UPJ处分级为阴性，1例为阳性。这2例患者在切除的下缘均为阴性分级。与UPJ（占8%）相比，更多患者（占24%）在切除的下缘为+++分级。
这是第一项将小儿患者UPJ中ICC状态与肾盂成形术结果相关联的研究。结果较差的2例患者在切除标本的下缘均无ICC，1例在UPJ处无ICC。UPJ和切除切缘处ICC数量存在统计学显著差异（P = 0.001）。
