儿童原发性膀胱输尿管反流手术干预相关因素分析

Predicative factors and optimal timing for surgical repair in children with primary vesicoureteral reflux

目的总结分析儿童膀胱输尿管反流需手术干预的相关因素,探讨儿童膀胱输尿管反流的手术治疗时机。 方法回顾性分析2012年11月至2019年6月中国医科大学附属盛京医院小儿外科经排尿期膀胱尿道造影(voiding cystourethrography,VCUG)诊断的儿童原发性膀胱输尿管反流患儿临床资料,总结其临床特点,并对其进行电话回访,收集患儿的临床资料及影像学资料,围绕是否需要手术干预进行单因素及多因素Logistic回归分析。 结果共84例膀胱输尿管反流患儿纳入研究,其中60例行保守治疗(对照组),24例行手术治疗(手术组),手术率28.6%。多因素Logistic回归分析发现患儿年龄、性别、身高、体重、反流发生时期、是否双侧反流、肾功能受损较重侧分肾功能情况、是否存在产前肾积水、是否因泌尿系统感染发现患病等因素尚未发现与手术干预存在关系( P >0.05),而高级别反流( OR =35.70,95%CI:2.87~444.77)和盆腔段输尿管直径( OR =2.26,95%CI:1.27~4.00),是VUR患儿需要手术干预的相关因素。 结论高级别的膀胱输尿管反流和盆腔段输尿管扩张直径>7.65 mm是膀胱输尿管反流患儿需要手术干预的相关因素,临床应积极治疗,严密监控,防止发生泌尿系统感染。

Objective To explore the relevant predicative factors and optimal surgical timing in children undergoing corrective surgery for vesicoureteral reflux (VUR). Methods A retrospective study was conducted for 84 children undergoing open surgical repair for VUR from November 2012 to June 2019. Clinical characteristics were collected for identifying the predictors of surgical interventions. And univariate and multivariable analyses were performed using the SPSS version 19 software package. Results Among them,24 cases (28.6%) underwent intravesical ureteroneocystostomy while another 60 (71.4%) were managed conservatively. Based upon multivariable analyses,age,gender,febrile urinary tract infections,maximal grade of reflux,prenatal hydronephrosis and VUR phase of voiding cystourethrogram were not the predictors of eventual surgery. Ureteral dilatation [ OR =2.26,95%CI(1.27-4.00)] and maximal grade of reflux [ OR =35.70,95%CI(2.87-444.77)] were among the strongest predictors of surgical interventions. Conclusion Higher grades of VUR and ureteral dilatation >7.65 mm were the strongest predictors of eventual surgical interventions.