小儿原发性膀胱输尿管返流的诊断与手术治疗(附39例报告)

Diagnosis and surgical management of primary vesico-ureteral reflux in children(report of 39 cases)

目的 总结小儿原发性膀胱输尿管返流 (PVUR)诊治经验。 方法 回顾分析PVUR39例的诊治资料 ,1例 4月龄婴儿做膀胱造口 ,2例患侧及 1例对侧并发肾发育异常者共做 3例肾切除 ,1例上尿路正常者用药物治疗 ,余 35例均行经膀胱内、外的横向推进抗返流输尿管膀胱再植术。 结果 35例 (92 % )术后效果满意 ,2例双侧病变者第一次手术仅做严重的一侧 ,术后尿内持续有脓细胞 ,复查时原对侧Ⅰ、Ⅱ度返流增重 ,经再次手术治愈。 1例手术后仍不能控制尿路感染 ,经患肾穿刺造瘘后好转。 结论 外科矫治PVUR(Ⅳ～Ⅴ )的手术成功率高 ,双侧病变一期完成双侧手术。 6月龄以内的PVUR(Ⅳ～Ⅴ )应做膀胱造口 ,周岁后考虑抗返流的输尿管膀胱再植术。

Objective To study the diagnosis and surgic al management of primary vesico-ureteral reflux in children. Method s 39 children,30 boys and 9 girls,with a mean age of 4,suffered fro m severe PVUR underwent surgical treatment including vesicostomy in 1,nephrectom y of the ipsilateral or contrala- teral kidney in 3 because of renal hypopla sia or dysplasia,and reimplantion of 55 ureters in 35 children. Resu lts Satisfactory results has been observed in 35(92%).In 2 cases of bilateral PVUR,reimplantation of the contralateral ureter was undertaken after t he first session of ureteral reimplantation on one side. Nephrostomy was underta ken in 1 becaus of uncontrolled infection after reimplantation. Conc lusions Surgical management is the treatment of choice for severe PV UR with a high successful rate.Bilateral ureteral reimplantation should be unde rtaken in one stage in cases even there was mild PVUR on one side.In young infa nts under 6 months,vesicostomy should be done first and ureteral reimplantation being done later.