Rodrigues Netto N, Ikari O, Esteves S C, D'Ancona C A
Division of Urology, University of Campinas Medical Center, São Paulo, Brazil.
Br J Urol. 1996 Oct;78(4):607-12. doi: 10.1046/j.1464-410x.1996.16419.x.
To compare the results of repairing pelvi-ureteric junction (PUJ) obstruction by percutaneous endopyelotomy in children with a similar series carried out in adults.
Nine children with primary (six) or secondary (three) PUJ obstruction were treated using a one-stage cold-knife percutaneous endopyelotomy. The success and morbidity rates were compared with a series of 61 adults with primary (46) or secondary (15) PUJ obstruction treated similarly.
In children, endopyelotomy was successful in five of six with primary and two of three with secondary PUJ obstruction, with a mean follow-up of 30 months (range 18-56). In the adults, endopyelotomy was successful in 38 of 46 (83%) with primary and 12 of 15 with secondary PUJ obstruction, an overall success rate of 82%, with a mean follow-up of 42 months (range 9-86). There was no statistical difference in the success rates with primary and secondary endopyelotomy between adults and children (P = 0.58). Failures were associated with high-grade hydronephrosis, a stenotic segment > 1.5 cm long and technical problems. Morbidity occurred in one of nine children and 3.2% of the adults.
This early experience suggests that percutaneous endopyelotomy can be performed safely and successfully in children with primary PUJ obstruction. However, in secondary stenosis, the results were less than optimal. Larger series should be analysed to form definitive conclusions on the role of endopyelotomy for the treatment of PUJ obstruction in children, given the high rate of success of open pyeloplasty and its minimal morbidity.
比较儿童经皮肾盂内切开术修复肾盂输尿管连接部（PUJ）梗阻的结果与成人中进行的类似系列手术的结果。
9例原发性（6例）或继发性（3例）PUJ梗阻患儿接受了一期冷刀经皮肾盂内切开术治疗。将成功率和发病率与61例原发性（46例）或继发性（15例）PUJ梗阻且接受类似治疗的成人患者系列进行比较。
在儿童中，原发性PUJ梗阻的6例中有5例、继发性PUJ梗阻的3例中有2例肾盂内切开术成功，平均随访30个月（范围18 - 56个月）。在成人中，原发性PUJ梗阻的46例中有38例（83%）、继发性PUJ梗阻的15例中有12例肾盂内切开术成功，总体成功率为82%，平均随访42个月（范围9 - 86个月）。成人和儿童原发性与继发性肾盂内切开术的成功率无统计学差异（P = 0.58）。失败与重度肾积水、狭窄段长度>1.5 cm以及技术问题有关。9例儿童中有1例、成人中有3.2%发生了并发症。
这一早期经验表明，经皮肾盂内切开术可安全、成功地应用于原发性PUJ梗阻患儿。然而，对于继发性狭窄，结果不太理想。鉴于开放性肾盂成形术成功率高且并发症极少，应分析更大规模的系列研究以就肾盂内切开术在儿童PUJ梗阻治疗中的作用得出明确结论。
