Skoog S J, Belman A B, Majd M
Department of Urology, Children's Hospital National Medical Center, Washington, D.C.
J Urol. 1987 Oct;138(4 Pt 2):941-6. doi: 10.1016/s0022-5347(17)43465-3.
We performed a retrospective review to evaluate the results of a nonsurgical approach to the management of primary vesicoureteral reflux during a 10-year period (1976 to 1986). During that interval patients with reflux were studied initially with a standard voiding cystourethrogram and either an excretory urogram or a renal scan with glomerular filtration rate and/or differential renal function determination. Height, weight, blood pressure, urine cultures and serum creatinine measurements also were obtained. Isotope cystography was used for followup examinations. A single, negative isotope cystogram was the radiological criterion for cessation of reflux. The charts of 545 children (55 per cent had bilateral reflux) with 844 refluxing ureters were reviewed. Based upon the international classification vesicoureteral reflux was grade I in 6.6 per cent of the cases, grade II in 54.2 per cent, grade III in 31.6 per cent, grade IV in 5.7 per cent and grade V in 1.9 per cent. All children were kept on long-term continuous prophylactic antibiotics and they were re-evaluated annually with isotope cystography. The followup rate for the entire group was 88 per cent. During the observation period spontaneous resolution of reflux was noted in 36 per cent of the patients and 39 per cent of the total refluxing ureters. Only 13 per cent of the entire group underwent surgical correction of reflux. Presently, 39 per cent (215) of the patients continue to be followed with reflux. Of the total group 66 patients (12 per cent) were lost to followup. In the 194 patients with spontaneous resolution of reflux the mean duration of reflux was 1.69 years, with 30 to 35 per cent resolving each year. Based on Student's t test there was a significant difference in duration of reflux in patients with grade II compared to grade III reflux (1.56 versus 1.97 years, p less than 0.04). When age at presentation was compared with duration of reflux there was a significantly shorter duration of reflux only in those patients presenting from age 0 to 12 months, compared to those 13 months and older (1.44 versus 1.85 years, p less than 0.02). Renal function was evaluated by serum creatinine, calculated glomerular filtration rate or differential diethylenetriaminepentaacetic acid scan results.(ABSTRACT TRUNCATED AT 400 WORDS)
我们进行了一项回顾性研究，以评估10年期间（1976年至1986年）非手术方法治疗原发性膀胱输尿管反流的结果。在此期间，对反流患者最初采用标准排尿膀胱尿道造影以及排泄性尿路造影或肾扫描，并测定肾小球滤过率和/或分肾功能。还获取了身高、体重、血压、尿培养结果和血清肌酐测量值。同位素膀胱造影用于随访检查。单次同位素膀胱造影结果为阴性是反流停止的放射学标准。我们回顾了545例儿童（55%为双侧反流）共844条反流输尿管的病历。根据国际分类，膀胱输尿管反流I级占6.6%，II级占54.2%，III级占31.6%，IV级占5.7%，V级占1.9%。所有儿童均长期持续使用预防性抗生素，并每年通过同位素膀胱造影进行重新评估。整个组的随访率为88%。在观察期内，36%的患者和39%的反流输尿管出现了反流的自发消退。整个组中只有13%的患者接受了反流的手术矫正。目前，39%（215例）的患者仍因反流接受随访。整个组中有66例患者（12%）失访。在194例反流自发消退的患者中，反流的平均持续时间为1.69年，每年有30%至35%的患者反流消退。基于学生t检验，II级反流患者与III级反流患者的反流持续时间存在显著差异（1.56年对1.97年，p<0.04）。将就诊时的年龄与反流持续时间进行比较时，与13个月及以上的患者相比，仅0至12个月就诊的患者反流持续时间明显较短（1.44年对1.85年，p<0.02）。通过血清肌酐、计算的肾小球滤过率或二乙三胺五乙酸扫描结果评估肾功能。（摘要截取自400字）
