Gordjani N, Frankenschmidt A, Zimmerhackl L B, Brandis M
Universitätskinderklinik, Freiburg, Germany.
Eur J Pediatr. 1996 Jun;155(6):491-4. doi: 10.1007/BF01955187.
Endoscopic subureteral collagen injection (SCIN) was performed in 24 girls and 5 boys (mean/range: 3.2/0.7-12.2 years) with primary grade III vesicoureteral reflux. Clinical outcome was compared to 20 girls and 6 boys treated by antireflux surgery (mean/range: 3.0/0.2-9.4 years). forty-one ureters were treated by endoscopy, 37 by surgery. Patients were followed for 12 months. SCIN was not associated with severe persistent complications. No reflux was detected immediately after SCIN. After 6 months recurrent grade II reflux was present in 1 (4%) surgically treated patient and in 12/29 (41%) patients treated by collagen injection. This corresponded to a recurrence rate of 1/37 (3%) of ureters following surgery and 15/41 (37%) following SCIN. 8/15 refluxing ureters after collagen showed decreased reflux grade (two grade I, six grade II). After 12 months 24/26 (92%) patients with antireflux surgery remained free of urinary tract infections as compared to 25/29 (86%) children following endoscopy. Following SCIN, 4/29 (14%) patients required secondary antireflux surgery because of recurrent urinary tract infections.
On the basis of this study endoscopic SCIN appears to be safe in children. It is less effective than surgery with regard to elimination of primary grade II reflux. However, clinical success rate is comparable to surgery with regard to the frequency of recurrent urinary tract infections after the procedure. This may be due to the reduction of refluxing urine volume in those patients who showed recurrence of reflux after collagen injection.
对24名女孩和5名男孩（平均/范围：3.2/0.7 - 12.2岁）进行了内镜下输尿管下胶原蛋白注射（SCIN），这些患儿患有原发性III级膀胱输尿管反流。将临床结果与20名女孩和6名男孩（平均/范围：3.0/0.2 - 9.4岁）接受抗反流手术的情况进行了比较。41条输尿管接受了内镜治疗，37条接受了手术治疗。对患者进行了12个月的随访。SCIN未出现严重的持续性并发症。SCIN后立即未检测到反流。6个月后，1例（4%）接受手术治疗的患者出现复发性II级反流，12/29例（41%）接受胶原蛋白注射治疗的患者出现复发性II级反流。这相当于手术后输尿管的复发率为1/37（3%），SCIN后为15/41（37%）。胶原蛋白注射后15条反流输尿管中有8条反流程度降低（2条I级，6条II级）。12个月后，26例接受抗反流手术的患者中有24例（92%）无尿路感染，而接受内镜治疗的29例儿童中有25例（约86%）无尿路感染。SCIN后，4/29例（14%）患者因复发性尿路感染需要二次抗反流手术。
基于本研究，内镜下SCIN在儿童中似乎是安全的。在消除原发性II级反流方面，其效果不如手术。然而，就术后复发性尿路感染的频率而言，临床成功率与手术相当。这可能是由于在胶原蛋白注射后出现反流复发的患者中，反流尿量减少。
