Diamond D A, Rabinowitz R, Hoenig D, Caldamone A A
University of Massachusetts Medical Center, Worcester, USA.
J Urol. 1996 Aug;156(2 Pt 2):665-7. doi: 10.1097/00005392-199608001-00026.
We studied a population of patients undergoing unilateral antireflux surgery to determine the mechanism of new onset contralateral reflux postoperatively.
A total of 141 patients underwent unilateral antireflux surgery via the Cohen, Glenn-Anderson or extravesical technique. The 18% of patients who had new onset contralateral vesicoureteral reflux were analyzed according to grade of initial reflux, presence of a Hutch diverticulum or duplex system and surgical technique.
Surgical technique did not influence the development of contralateral reflux. As grade of corrected reflux increased, a significant trend toward development of contralateral reflux was noted. A Hutch diverticulum was not a risk factor for contralateral reflux but reflux into a duplicated system was a distinct risk factor (26 versus 12% in single system reflux).
Our study supports the concept that new onset contralateral reflux may result from elimination of a pop-off mechanism. Surgical distortion of the contralateral hemi-trigone appears not to be responsible. Correction of severe (grade V) reflux and reflux into duplex systems put patients at particular risk for development of contralateral reflux postoperatively.
我们对接受单侧抗反流手术的患者群体进行了研究，以确定术后对侧新发反流的机制。
共有141例患者通过科恩（Cohen）、格伦 - 安德森（Glenn - Anderson）或膀胱外技术接受了单侧抗反流手术。对出现对侧新发膀胱输尿管反流的18%的患者，根据初始反流程度、是否存在哈钦憩室或重复系统以及手术技术进行了分析。
手术技术不影响对侧反流的发生。随着矫正反流程度的增加，对侧反流发生的显著趋势被注意到。哈钦憩室不是对侧反流的危险因素，但反流至重复系统是一个明显的危险因素（单系统反流中为12%，重复系统反流中为26%）。
我们的研究支持这样的观点，即对侧新发反流可能是由于“安全阀”机制的消除所致。对侧半三角区的手术变形似乎与此无关。重度（V级）反流的矫正以及反流至重复系统使患者术后发生对侧反流的风险特别高。
