Fang Yiwei,Lin Defu,Sun Ning,et al.Treatment experience for recurrent primary vesicoureteral reflux in children after surgery[J].Journal of Clinical Pediatric Surgery,2025,(07):618-621.[doi:10.3760/cma.j.cn101785-202503035-004]
儿童原发性膀胱输尿管反流手术后复发的治疗探讨
- Title:
- Treatment experience for recurrent primary vesicoureteral reflux in children after surgery
- Keywords:
- Vesicoureteral Reflux; Urinary Bladder; Neurogenic; Recurrence; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)手术后复发的临床特点及个体化治疗策略。方法 回顾性分析2019年6月至2023年3月首都医科大学附属北京儿童医院收治的22例原发性VUR手术后复发患儿临床资料。男16例,女6例;首次手术时年龄13~143个月,平均71个月;术后复发的治疗方案:保守治疗13例(抗感染+抗胆碱药物),再次手术治疗9例(腹腔镜Lich-Gregoir术、腹腔镜改良Lich-Gregoir术或开腹膀胱输尿管再植术)。定期随访泌尿系超声、血生化、尿常规以及排尿性膀胱尿道造影,了解患儿治疗效果。结果 22例中,13例(59.1%)保守治疗中,1例痊愈,5例反流降级,7例反流等级不变。6例高级别反流(Ⅳ~Ⅴ级)合并膀胱结构异常(憩室、小梁化)者保守治疗失败,行再次手术后获治愈(或反流显著减轻),再次手术方式为:开放输尿管再植术(Cohen术)2例、腹腔镜Lich-Gregoir术2例、腹腔镜改良Lich-Gregoir术2例。1例因术后肾功能异常,再次行腹腔镜改良Lich-Gregoir术,术后2年反流治愈。2例因初次手术后反流加重,再次行腹腔镜改良Lich-Gregoir术,术后1年复查反流降为Ⅱ级。结论 儿童原发性VUR术后复发可能与膀胱功能异常及解剖缺陷有关。保守治疗适用于低级别反流且膀胱功能可控者,而高级别反流合并解剖异常者需早期手术干预。
- Abstract:
- Objective To explore the clinical characteristics and individualized treatment strategies for postoperative recurrence of primary vesicoureteral reflux (PVUR) in children. Methods A retrospective analysis was conducted for the relevant clinical data of 22 children with postoperative recurrence of PVUR from June 2019 to March 2023.There were 16 boys and 6 girls with an average age of 71(13-143) months during initial surgery.The treatment groups included 13 cases of conservative measures (adjusting anti-infective regimen+improving bladder function) or 9 cases of surgery (Lich-Gregoir laparoscopy,modified Lich-Gregoir laparoscopy or open bladder ureteric reimplantation).The contributing factors to recurrence and treatment outcomes were examined. Results After conservative measures of anti-infective+anticholinergic drugs,59.1%(13/22) showed improvement or non-progression of reflux.The outcomes were cure (n=1),downgraded (n=5) and non-change of reflux grade (n=7).Six cases of high-grade reflux (Ⅳ-Ⅴ) with bladder structural abnormalities of diverticulum and trabeculation were non-responsive to conservative measures.There were cure and markedly reduced reflux after reoperation.The surgical procedures were open ureteric reimplantation (Cohen procedure,n=2),Lich-Gregoir laparoscopy (n=2) and modified Lich-Gregoir laparoscopy (n=2).One child of postoperative renal dysfunction underwent modified Lich-Gregoir laparoscopy and reflux was cured after 2 years.Two children of worsening reflux after initial surgery showed no improvement.Both underwent modified Lich-Gregoir laparoscopy and reflux downgraded to grade Ⅱ during 1-year follow-ups. Conclusions Postoperative recurrence of PVUR is closely correlated with bladder dysfunction and anatomical defects in children.Conservative measures are indicated for low-grade reflux with controllable bladder function while early surgical intervention is required for high-grade reflux with anatomical abnormalities.Individualized stratified management of combining bladder function assessment with surgical optimization can effectively improve outcomes.Long-term follow-ups and renal function monitoring are mandatory.
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备注/Memo
收稿日期:2025-3-12。
基金项目:北京市科委、中关村管委会“医药创新品种及平台培育”专项资助(Z231100004823034)
通讯作者:林德富,Email:15901103362@139.com