输尿管置管用于小婴儿后尿道瓣膜症初期治疗的研究

Ureter stenting in the early treatment of infantile posterior urethral valves

目的探索在目前尿道瓣膜治疗基础上，输尿管置管运用于部分小婴儿尿道瓣膜症初期治疗的初步效果。方法回顾性分析2011年8月至2016年12月间在复旦大学附属儿科医院收治的后尿道瓣膜症患儿病史资料，并进行随访资料的统计分析。统计患儿的首诊年龄，初次就诊的血清肌酐水平，根据患儿在治疗中所接受的处理方式，分为瓣膜切开组、膀胱造口及瓣膜切开组和输尿管置管及瓣膜切开组。比较随访中各组血清肌酐值在术后6～9个月时的变化，统计随访时限，随访血清肌酐值在随访终末的变化，以及同位素分肾功能测量的肾小球滤过率（GFR）的变化值，进行组间比较。结果63例患儿纳入研究，其中输尿管置管及瓣膜切开组14例，膀胱造口及瓣膜切开组14例，瓣膜切开组35例。输尿管置管及瓣膜切开组患儿首诊时初始肌酐值为119.3 μmol/L，高于瓣膜切开组（51.5 μmol/L），P〈0.05，差异具有统计学意义，而和膀胱造口及瓣膜切开组（83.2 μmol/L）相比，差异无统计学意义。术后6～9个月内随访血清肌酐值，输尿管置管及瓣膜切开组为26.8 μmol/L，而膀胱造口及瓣膜切开组、瓣膜切开组分别为46.6 μmol/L和29.9 μmol/L，组间差异无统计学意义。中期随访中，获得随访患儿术后9个月以上的最近一次血清肌酐值，在输尿管置管及瓣膜切开组、膀胱造口及瓣膜切开组、瓣膜切开组分别为40.6 μmol/L、38.1 μmol/L、36.3 μmol/L，组间差异无统计学意义。通过同位素动态显像计算GFR，各组在随访中GFR值的增加量，输尿管置管及瓣膜切开组为20.8 ml/min，分别高于膀胱造口及瓣膜切开组和瓣膜切开组的9.9 ml/min和12.0 ml/min，但差异没有统计学意义。结论对于输尿管末端引流不畅的后尿道瓣膜症患儿，进行输尿管置管支撑输尿管膀胱连接处，有助于改善输尿管引流，有益于肾功能的早期恢复。

ObjectiveTo explore the efficacy of ureter stenting in the early treatment of infantile posterior urethral valve by measuring renal functions. MethodsClinical data of 63 patients diagnosed with posterior urethral valve at our hospital were analyzed retrospectively. Age of patients at diagnosis, serum creatinine level before initial treatment and follow-up were collected. According to treatments, they were divided into 3 groups of ureter stenting （n=14）, vesicostomy （n=14） and valve ablation （n=35）. The postoperative changes of serum creatinine in each group were compared. The serum creatinine values and increments of glomerular filtration rate （GFR） were tracked at the end of follow-up period.ResultsThe initial serum creatinine value in ureter stent group was higher than that of valve ablation group （119.3 μmol/L vs. 51.5 μmol/L, P〈0.05）. There was statistically significant difference, but it had no significant difference with vesicostomy group （83.2 μmol/L）. The serum creatinine values were tracked postoperatively for 6-9 months, and the serum creatinine values were 26.8, 46.6 and 29.9 μmol/L respectively in ureter stenting, vesicostomy and valve ablation groups. And the difference was not statistically significant. With medium-term follow-up, they were 40.6, 38.1 and 36.3 μmol/L respectively. As calculated by 99 mTc-DTPA renal dynamic imaging, the increments of GFR were 20.8, 9.9 and 12.0 ml/min respectively in ureter stenting, vesicostomy and valve ablation groups. And the differences were not statistically significant.ConclusionsUreter stenting may benefit infants of obstructed ureter with posterior urethral valve and there is an advantage of early recovery of kidney function.