Liu C, Chin T, Wei C
Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan, Republic of China.
J Pediatr Surg. 1998 Nov;33(11):1716-9. doi: 10.1016/s0022-3468(98)90617-0.
Surgical treatment for vesicoureteral reflux (VUR) is controversial in infants, especially small infants because of technical difficulty and higher rate of spontaneous resolution. However, in some conditions, such as high-grade reflux, breakthrough infection, or severe renal scarring, early operation may be justified. This study is to evaluate the results of ureteral reimplantation in infants with VUR under 3 months of age.
From January 1993 to July 1997, 13 boys and five girls (24 ureters) under 3 months of age (range, 18 days to 3 months; mean age, 2 months) received ureteral reimplantation for VUR. The initial symptoms were urinary tract infection (UTI) in 16 infants, hydronephrosis found by prenatal ultrasound scan in one, and early postnatal screening ultrasound scan in one. The indications for 24 ureter reimplantations were high-grade reflux (grade V, n = 7), breakthrough infection under medical treatment (n = 5), and severe renal scarring (n = 8) and contralateral low-grade refluxing ureters (n = 4). All patients had Glenn-Anderson's or Cohen's ureteral reimplantation. Ureteral stents were required in six ureters. All patients had renal sonogram 1 month after operation to rule out ureteral obstruction. Fifteen patients had voiding cystourethrogram (VCUG) after operation. Renal growth was evaluated in 15 patients (20 reflux renal units) using serial ultrasound or differential perfusion renal scan. The operative time, use of ureteral stent, complication rate, hospital stay, and time needed for clearing urine, were compared with those of 115 counterpart patients at age over 3 months. Data were analyzed using X(2) test or t test.
All patients, except one, were free of UTI during the follow-up of 6 months to 5 years. In fifteen infants who had postoperative VCUG, 14 were free of reflux, and one had persistent lower-grade VUR. One patient had transient ureteral obstruction that resolved spontaneously. One patient had postoperative ileus for 2 weeks. Renal growth of 20 reflux renal units was similar to that of the contralateral nonreflux kidneys. The only significant difference when compared with the patients over 3 months of age, was the higher incidence of ureteral stenting (25% v 4.2%, P<.01).
Ureteral reimplantation should be performed in infants under 3 months of age when it is indicated.
膀胱输尿管反流（VUR）的手术治疗在婴儿中存在争议，尤其是小婴儿，因为技术难度大且自然缓解率较高。然而，在某些情况下，如重度反流、突破性感染或严重肾瘢痕形成，早期手术可能是合理的。本研究旨在评估3个月以下VUR婴儿输尿管再植术的结果。
1993年1月至1997年7月，13例男孩和5例女孩（24条输尿管），年龄在3个月以下（范围18天至3个月；平均年龄2个月）因VUR接受输尿管再植术。最初症状为16例婴儿的尿路感染（UTI），1例产前超声检查发现肾积水，1例出生后早期筛查超声检查发现肾积水。24条输尿管再植的指征为重度反流（V级，n = 7）、内科治疗下的突破性感染（n = 5）、严重肾瘢痕形成（n = 8）以及对侧轻度反流输尿管（n = 4）。所有患者均行格伦 - 安德森或科恩输尿管再植术。6条输尿管需要放置输尿管支架。所有患者术后1个月行肾脏超声检查以排除输尿管梗阻。15例患者术后行排尿性膀胱尿道造影（VCUG）。15例患者（20个反流肾单位）通过系列超声或肾灌注差示扫描评估肾脏生长情况。将手术时间、输尿管支架使用情况、并发症发生率、住院时间以及尿液清除所需时间与115例3个月以上的对应患者进行比较。数据采用X²检验或t检验进行分析。
除1例患者外，所有患者在6个月至5年的随访期间均无UTI。15例术后行VCUG的婴儿中，14例无反流，1例持续存在轻度VUR。1例患者出现短暂性输尿管梗阻，自行缓解。1例患者术后肠梗阻持续2周。20个反流肾单位的肾脏生长情况与对侧无反流肾脏相似。与3个月以上患者相比，唯一显著差异是输尿管支架置入率较高（25%对4.2%，P <.01）。
有指征时，3个月以下婴儿应行输尿管再植术。
