Jelloul L, Berger D, Frey P
Department of Pediatric Surgery, University Hospital of Lausanne (CHUV), Switzerland.
Eur Urol. 1997;32(3):321-6; discussion 327.
Treatment of ureteroceles in children varies according to the anatomicopathological form and the choice of the surgical team. This study tries to determine the exact value of the endoscopic management of ureteroceles in children.
Between 1987 and 1993, 11 ureteroceles in 10 children were treated by endoscopic incision: 7 intravesical ureteroceles (4 single system and 3 duplex system) and 4 duplex-system ectopic ureteroceles. The procedure consists of a tiny transversal incision at the lower and median aspects of the ureterocele.
The dilation of the upper urinary tract disappeared or decreased in all cases of intravesical ureteroceles and in half the cases of ectopic ureteroceles. Endoscopic incision of the ureterocele led to a vesicoureteral reflux in the associated ureter in 6 cases: 54.5% (43% of the intravesical ureteroceles, 75% of the ectopic ureteroceles). Following endoscopic treatment, no further surgery was required in 5 of the 7 cases with intravesical ureteroceles (71.5%), while every case of ectopic ureterocele needed a further operation (lower tract surgery in 3 cases, upper tract surgery in 1 case).
Endoscopic incision of ureteroceles is a simple and quick procedure which allows obstruction to be removed and the dilation of the upper urinary tract and its corresponding kidney function to be improved, particularly in the neonate. The endoscopic management of ureteroceles may in itself suffice, without necessity of further surgery. These favorable results can more readily be seen in cases of intravesical ureterocele than in those of ectopic ureterocele.
儿童输尿管囊肿的治疗因解剖病理形式及手术团队的选择而异。本研究旨在确定儿童输尿管囊肿内镜治疗的确切价值。
1987年至1993年间，对10例儿童的11个输尿管囊肿进行了内镜下切开治疗：7例膀胱内输尿管囊肿（4例单系统，3例重复系统）和4例重复系统异位输尿管囊肿。该手术包括在输尿管囊肿的下部和中部做一个微小的横向切口。
所有膀胱内输尿管囊肿病例以及半数异位输尿管囊肿病例的上尿路扩张消失或减轻。输尿管囊肿内镜下切开导致6例相关输尿管出现膀胱输尿管反流：占54.5%（膀胱内输尿管囊肿的43%，异位输尿管囊肿的75%）。内镜治疗后，7例膀胱内输尿管囊肿中有5例（71.5%）无需进一步手术，而异位输尿管囊肿的每个病例均需要进一步手术（3例下尿路手术，1例上尿路手术）。
输尿管囊肿内镜下切开是一种简单快捷的手术，可解除梗阻，改善上尿路扩张及其相应的肾功能，尤其是在新生儿中。输尿管囊肿的内镜治疗本身可能就足够了，无需进一步手术。膀胱内输尿管囊肿病例比异位输尿管囊肿病例更容易出现这些良好结果。
