Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France.
Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France.
J Pediatr Urol. 2018 Oct;14(5):382-387. doi: 10.1016/j.jpurol.2018.05.027. Epub 2018 Jun 28.
The aims of this study were to evaluate the efficacy and safety of endoscopic treatment of primary obstructive megaureter in children, and to assess its long-term outcome.
Case files of 35 children who had endoscopic treatment of symptomatic primary obstructive megaureter between 2006 and 2016 were retrospectively analyzed. All children had ureterovesical junction dilatation with one or more ureteral dilators, and insertion of a JJ stent. An analysis of the case files and a comparison between pre- and postoperative ultrasound and scintigraphy findings were performed.
The study population consisted of 22 boys and 13 girls aged between 2 months and 16 years. The follow-up period ranged from 8 months to 10 years. Twenty-one children (60%) were under 2 years at the time of treatment. The average duration of JJ stenting was 7 weeks (3-16 weeks). Thirty-four of 35 children (97%) were considered definitively cured, that is, asymptomatic with preserved renal function. Two children required open surgery for a failed endoscopic treatment procedure. Secondary reimplantation surgery was only necessary in one case (1/35) after technically satisfactory endoscopic treatment. Twelve of 35 children had a complication, including two Clavien III complications. Comparison of pre- and postoperative ultrasonography showed a significant decrease in ureteral diameter in 31 cases. Postoperative scintigraphy showed a significant improvement in the ureteral leaking curve in 20 children.
In our experience, endoscopic treatment of congenital obstructive megaureter in pediatrics seems to be safe and effective. It is proposed as a first-line treatment for children requiring an intervention, even for young children under 2 years.
本研究旨在评估内镜治疗儿童原发性梗阻性巨输尿管的疗效和安全性，并评估其长期结果。
回顾性分析 2006 年至 2016 年间接受内镜治疗有症状原发性梗阻性巨输尿管的 35 例儿童的病例资料。所有儿童均存在输尿管膀胱连接部扩张，使用一个或多个输尿管扩张器，并插入 JJ 支架。对病例资料进行分析，并对术前和术后超声及闪烁扫描结果进行比较。
研究人群包括 22 名男孩和 13 名女孩，年龄在 2 个月至 16 岁之间。随访时间为 8 个月至 10 年。21 例患儿（60%）在治疗时年龄小于 2 岁。JJ 支架留置时间平均为 7 周（3-16 周）。35 例儿童中有 34 例（97%）被认为是明确治愈的，即无症状且肾功能保留。2 例儿童因内镜治疗失败而需要开放手术。在技术上满意的内镜治疗后，仅 1 例（1/35）需要进行二次再植入手术。35 例儿童中有 12 例出现并发症，包括 2 例 Clavien III 级并发症。与术前超声比较，31 例输尿管直径明显缩小。20 例儿童术后闪烁扫描显示输尿管漏曲线明显改善。
根据我们的经验，内镜治疗小儿先天性梗阻性巨输尿管似乎是安全有效的。它被提议作为需要干预的儿童的一线治疗方法，甚至适用于 2 岁以下的幼儿。
