经尿道瓣膜切开手术对后尿道瓣膜合并膀胱输尿管反流的影响

Outcome of vesicoureteral reflux in patients with posterior urethral valves after primary valve ablation

目的探讨经尿道瓣膜切开手术后后尿道瓣膜合并膀胱输尿管反流及肾积水的变化情况。方法回顾性分析首都医科大学北京儿童医院2010年1月至2016年1月收治的19例后尿道瓣膜合并膀胱输尿管反流患儿的临床资料。患儿年龄6~182个月,平均(27.4±7.2)个月;单侧反流12例,双侧反流7例;均行经尿道瓣膜切除术。分析患儿术前、术后6个月及术后1年肾盂前后径、输尿管宽度、肾实质厚度及膀胱输尿管反流程度的变化情况。结果19例术后随访13~84个月,平均(38.8±9.8)个月;与术前相比,患儿术后1年肾盂前后径及输尿管宽度变小,肾实质厚度增加(P<0.05);术后1年膀胱输尿管反流消退比例为68.4%(13/19),术后6个月轻度反流和重度反流改善率分别为40%和36.3%,术后1年分别为53.3%和45.4%。对6例瓣膜切开术后仍有持续反流的患儿行尿动力学检查,其中4例表现为逼尿肌不稳定,3例表现为膀胱顺应性差。结论经尿道瓣膜切开手术可以改善后尿道瓣膜所致的膀胱输尿管反流及肾积水,对于后尿道瓣膜切开术后反流仍持续或加重的患儿建议行尿动力学检查,并随访膀胱功能。

Objective To summarize our institutional experience in the management of posterior urethral valves and analyze the effect of primary valve ablation on vesicoureteral reflux and hydronephrosis.Methods We retrospectively analyzed the records of 19 selected boys diagnosed with vesicoureteral reflux with posterior urethral valve from January 2010 to January 2016.The 19 patients were aged 6 months to 182 months[(27.4±7.2)months].The patitents who had reflux at presentation,which were unilateral in 12 and bilateral in 7 patients.They were taken ultrasonography detecting hydronephrosis and voiding cystoureterography detecting vesicoureteral reflux at baseline,6 months and 12 months after valve ablation.Results Nineteen patients were followed up for 13 months to 84 months[(38.8±9.8)months].The diameter of the pelvis and ureter decreased and the renal parenchymal thickness increased 1 year after valve ablation(P<0.05).Reflux resolved after relief of obstruction in 13/19(68.4%)patients.The reflux more often resolved in low-grade reflux than high group(40%of units versus 36.6%)6 months after operation and(53.5%of units versus 45.4%).Persistent vesicoureteral reflux was detected in 6 boys and postoperative urodynamic study was underwent,detrusor instability was detected in 4 boys and 3 developed low compliance.Conclusion Primary valve ablation can lead to improvement in VUR and hydronephrosis.More attention should be paid to bladder function of patients with persist VUR after valve ablation.