经内镜电灼术治疗小儿后尿道瓣膜症

Clinical analysis of endoscopic fuiguration of posterior urethral valve in children

目的探讨内镜电灼术治疗小儿后尿道瓣膜的临床效果。方法对45例经内镜电灼术治疗后的小儿后尿道瓣膜进行回顾性分析。本组病例均为男性，年龄2周～15岁，中位年龄3岁。婴幼儿用6／7．5F输尿管镜或9F膀胱尿道镜和Bugbee针状电极，大龄儿用12F或13F膀胱镜和钩状电极，在尿道的5点、7点和12点处电灼后尿道瓣膜。术后长期随访。结果根据Young分型，本组患儿中I型44例，Ⅲ型1例，术中顺利，术后排尿通畅度改善（尿线明显增粗，最大尿流率均在16．50ml／s以上），血肌酐水平恢复正常，尿白细胞消失，肾积水程度均不同程度减轻（35例肾积水患儿中12例轻度肾积水消失，16例中度肾积水转为轻度肾积水，7例重度肾积水转为中度肾积水），膀胱输尿管反流程度较术前均有明显改善（29例膀胱输尿管反流的患儿中16例患儿反流消失，6例反流程度由术前Ⅱ度转为I度，4例患儿由术前Ⅳ度转为Ⅱ度，3例患儿由术前V度转为Ⅲ度）。结论内镜下电灼术治疗后尿道瓣膜症是一种可行的方法，疗效确切，术后并发症少，预后好。针状电极可明显减少尿道狭窄的发生率。

Objective The aim of this study was to assess the effectiveness of endoscopic abla- tion of posterior urethral valves. Methods We retrospectively reviewed a database of 45 patients with PUV treated by endoscopic valve ablation. In this study, all patients were diagnosed at the age of 3 years （range：2 weeks to 15 years）. 6/7. 5F ureteroscopy and 9F cystoscopy with needle electrode were used in infants,whereas 12F or 13F cystoscopy and hook electrode were used in older children. The valves were ablated mainly at the 5,7 and 12 o＇clock positions. The patients were followed up after surgery. Results Based on Young＇s classification,there were 44 typeⅠ and 1 typeⅢ PUV in this stud- y. Urine line became thicker, the maximum flow rate can be achieved more than 16. 50 ml/s. Serum cre- atinine returned to normal and white blood cells in urine disappeared. The degree of dilatation of hydro- nephrosis relieved （among 35 hydronephrosis patients, 12 cases disappeared, 16 mild hydronephrosis to moderate hydronephrosis and 7 severe hydr0nephrosis to moderate hydronephrosis）. Compared to pre- operation, vesicoureteral reflux had a significantly improved （among 29 cases, 16 reflux disappeared, 6 grade Ⅱ to grade I ,4 grade Ⅳ to Ⅱand 3 grade V to grade Ⅲ ）. Conclusions Endoscopic ablation in treating pediatric posterior urethral valves seems to he safe and is associated with low rate of post- operative complications. Needle electrode can reduce the rate of urethral stricture.