儿童原发性膀胱输尿管反流72例

Primary vesicoureteric reflux in 72 children

目的总结原发性膀胱输尿管反流(PVUR)的治疗方式、预后及其与泌尿系统感染(UTI)的关系。方法以2007年6月至2018年4月于首都儿科研究所附属儿童医院肾脏内科及泌尿外科住院确诊PVUR的72例患儿为研究对象,分析其临床资料。结果72例PVUR患儿,男52例,女20例,诊断中位数年龄8个月,1岁以内确诊者44例(61.1%);以UTI起病者55例(76.4%),其中发生2次及2次以上UTI者占94.5%(52/55例);肾功能不全者2例(2.8%)。72例患儿单侧反流34例、双侧38例,共有110根反流输尿管,其中低级别反流(Ⅰ~Ⅲ级)74根(67.3%),高级别反流(Ⅳ~Ⅴ级)36根(32.7%)。40例患儿行内科治疗,其中Ⅰ~Ⅱ级反流完全缓解率为72.2%(13/18例),Ⅲ~Ⅴ级反流完全缓解率为32.5%(13/40例),二者比较差异有统计学意义(χ2=7.92,P=0.005)。22例患儿(35根输尿管)行外科手术治疗,31根治愈,完全缓解率达88.6%。10例存在单侧或双侧Ⅲ级及Ⅲ级以上级别反流的患儿,先经内科治疗无好转,后行外科手术治疗反流均完全缓解。结论反复UTI患儿,尤其1岁以内者应警惕PVUR;Ⅰ~Ⅱ级反流可首选内科保守治疗,高级别反流、双侧反流及内科治疗反流不能缓解且反复发生UTI者,可早期接受外科手术治疗,以减少发生反流性肾病。

Objective To summarize the treatment and prognosis of children with primary vesicoureteric reflux (PVUR) and the correlation between PVUR and urinary tract infections(UTI). Methods The children with PVUR (72 cases) who were hospitalized at the Department of Nephrology and Urology of Children′s Hospital Affiliated to Capital Institute of Pediatrics from June 2007 to April 2018 were selected, and the clinical manifestations were summarized. Results A total of 72 patients (52 boys, 20 girls) were involved, and the median age at diagnosis was 8 months, in which 44 cases (61.1%) were less than 1 year old.There were 55 cases with UTI onset (76.4%), 94.5%(52/55 cases) with recurrent UTI(twice or more than twice) and 2 cases (2.8%) ended with renal failure.Refluxes were unilateral in 34 patients and bilateral in 38 patients.There were 110 ureters, in which 74 reflux ureters (67.3%) were identified as low-grade (Ⅰ-Ⅲ) PVUR, and 36 reflux ureters(32.7%) were high-grade (Ⅳ-Ⅴ) PVUR.Forty patients received conservative treatment, and significant differences of the remission rate were observed between group Ⅰ-Ⅱ grade PVUR(72.2%, 13/18 cases) and group Ⅲ-Ⅴ grade PVUR(32.5%, 13/40 cases)(χ2=7.92, P=0.005). Twenty-two patients (35 reflux ureters) underwent surgical treatment, in which 31 ureters were cured, and the remission rate was 88.6%.Ten patients with refluxes grade Ⅲ or above had no improvement after medical treatment, but the reflux was completely relieved after surgical treatment. Conclusions Children with recurrent UTI, especially less than 1 year-old, should be considered with PVUR.The conservative treatment could be prior for the patients with Ⅰ-Ⅱ grade PVUR.The surgical treatment could be chosen for those patients who suffered from high-grade PVUR, bilateral reflux or failed conservative treatment, especially with recurrent UTI, and reflux nephropathy could be reduced then.