Kumon H, Tsugawa M, Ozawa H, Monden K, Ohmori H
Department of Urology, Okayama University Medical School, Shikata, Japan.
Int J Urol. 1997 Nov;4(6):541-5. doi: 10.1111/j.1442-2042.1997.tb00305.x.
Endoscopic correction of vesicoureteral reflux (VUR) was first proposed in 1981 and the first series of patients treated by subureteric polytetrafluoroethylene paste injection (STING) was reported in 1984. Although many successful studies, primarily European, have been undertaken since then, this technique has recently been rejected in the United States. In this paper, we report our 6-year experience and discuss indications for this technique.
Since February 1990, we have used the STING technique to endoscopically correct VUR. In this analysis, 38 ureters in 24 patients (mean age, 47.3 years; range, 7 to 79 years), with at least 1 year of follow-up were included.
The first injection resulted in disappearance of VUR in 34 ureters (89.5%). A second injection was done for 2 failed and 3 recurrent ureters during follow-up, resulting in disappearance of VUR in the 3 recurrent ureters. The final success rates were 100% for both primary VUR and secondary VUR due to neurogenic bladder, but only 55.6% (5/9) for secondary VUR following transurethral resection of bladder tumors. No postoperative early or delayed complications were noted in any case.
The procedure is simple and effective for the treatment of all grades of VUR. However, the procedure should be performed after careful consideration of the indications, since theoretically the risk of distant migration of the paste cannot be ignored.
1981年首次提出经内镜矫正膀胱输尿管反流（VUR），1984年报道了首例采用输尿管下聚四氟乙烯糊剂注射（STING）治疗的患者系列。尽管自那时以来已经开展了许多主要是欧洲的成功研究，但该技术最近在美国已被摒弃。在本文中，我们报告了我们6年的经验并讨论了该技术的适应证。
自1990年2月以来，我们采用STING技术经内镜矫正VUR。在该分析中，纳入了24例患者（平均年龄47.3岁；范围7至79岁）的38条输尿管，随访时间至少1年。
首次注射后34条输尿管（89.5%）的VUR消失。随访期间对2条失败输尿管和3条复发输尿管进行了第二次注射，3条复发输尿管的VUR消失。原发性VUR和神经源性膀胱所致继发性VUR的最终成功率均为100%，但经尿道膀胱肿瘤切除术后继发性VUR的成功率仅为55.6%（5/9）。所有病例均未观察到术后早期或延迟并发症。
该手术对于治疗所有分级的VUR简单有效。然而,由于理论上糊剂远处迁移的风险不可忽视，应在仔细考虑适应证后再进行该手术。
