Chen Guangjie,Wang Xiaohao,Zhao Yijun,et al.A preliminary report of endoscopic injection of dextranomer/hyaluronic acid in children with primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2019,18(10):820-824.[doi:10.3969/j.issn.1671-6353.2019.10.004]
透明质酸钠凝胶注射治疗原发性膀胱输尿管反流的效果分析
- Title:
- A preliminary report of endoscopic injection of dextranomer/hyaluronic acid in children with primary vesicoureteral reflux
- Keywords:
- Kidney/IN; Vesico-Ureteral Reflux; Injections; Hyaluronic Acid; Therapy
- 分类号:
- R726.9;R692.2;R693
- 摘要:
- 目的 初步探讨透明质酸钠凝胶注射治疗原发性膀胱输尿管反流的价值。方法 回顾性分析2017年11月至2019年6月15例入选"黏膜填充用修饰透明质酸钠凝胶"临床试验的原发性膀胱输尿管反流患儿的临床资料。随机分配到试验组（n=8）和对照组（n=7）。试验组于膀胱镜黏膜下注射透明质酸钠凝胶，术后12周复查排尿期膀胱尿路造影（voiding cystourethrography，VCUG），如效果不佳则再次注射，术后52周再次评估，反流消失为成功，降级为好转。对照组予"呋喃妥因/SMZ"连续预防性使用抗生素（continuous antibiotic prophylaxis，CAP）。出现反复/不可控制感染、肾功能损害等情况则退出试验转其他治疗方式。结果 试验组8例患儿11条输尿管，其中男童3例，女童5例；年龄1岁至15岁6个月；单侧5例，双侧3例；左侧7条，右侧4条；反流Ⅱ级2条，Ⅲ级6条，Ⅳ级3条。注射剂量0.2~2.0 mL，经尿道输尿管口下注射术（subureteral transurethal injection，STING）治疗6例患儿9条输尿管，DHIT注射2例患儿2条输尿管。术后12周评估反流消失2条（Ⅲ级2条），成功率22.2%；降级4条（Ⅲ级3条，Ⅳ级1条），好转率44.4%；无变化1条（Ⅳ级）；升级1例患儿2条输尿管（Ⅱ级升级为Ⅲ级）；2条输尿管未到术后12周复查时间。再次注射3例患儿4条输尿管。2条Ⅲ级反流输尿管术后52周行VCUG评估，1条消失，1条降级为Ⅰ级。所有患儿注射后未出现不适症状。对照组7例患儿8条输尿管，其中男童1例，女童6例；年龄1岁5个月至7岁8个月，单侧6例，双侧1例；左侧6条，右侧2条；Ⅱ级4条，Ⅲ级3条，Ⅳ级1条；予呋喃妥因/SMZ CAP治疗。有2例患儿2条Ⅲ级输尿管因家长焦虑的情绪退出试验改行手术治疗，52周复查1条Ⅲ级输尿管降级为Ⅰ级，其余未到复查时间。结论 膀胱镜透明质酸钠凝胶注射治疗原发性膀胱输尿管反流是安全有效的。
- Abstract:
- Objective To explore preliminarily the role of endoscopic injection of dextranomer/hyaluronic acid in children with primary vesicoureteral reflux.Methods From November 2017 to June 2019,a retrospective analysis was conducted for 15 children with primary vesicoureteral reflux receiving an endoscopic injection of dextranomer/hyaluronic acid.Experiment and control groups were randomly assigned.Experiment group(n=8) received an endoscopic injection of dextranomer/hyaluronic acid.Voiding cystourethrography was assessed at Week 12 post-operation.For ineffective cases,another injection was offered and re-examination performed at Week 52 post-operation.Reflux disappearing and degrading were judged successful and improving respectively.Control group(n=7) was treated with continuous antibiotic prophylaxis (CAP) of nitrofurantoin or sulfamethoxazole.Children with recurrent or uncontrolled urinary infection and renal function damage withdrew from clinical trial and received other treatments.Results Experiment group:8 children with 11 ureters.There were 3 boys and 5 girls with an age range of 12-186 months.The sideness was unilateral (n=5) and bilateral (n=3).And the involved side of ureter was left (n=7) and right (n=4); the grade of reflux was Ⅱ (n=2),Ⅲ (n=6) and Ⅳ (n=3).The injection dose was 0.2-2.0 ml.The injection mode was subureteral transurethral injection (n=9 in 6 children) and double hydrodistention implantation technique (n=2 in 2 children).Assessment at Week 12 post-operation revealed disappearing (n=2 grade Ⅲ),success rate 22.2%; degrading (n=3 grade Ⅲ; n=1 grade Ⅳ),improving rate 44.4%; unchanged (n=1 grade Ⅳ); upgrading (n=2 in 1 child,grade Ⅱ→Ⅲ).Two ureters were to be re-examined at Week 12 post-operation.Four ureters in 3 children received another injection.VCUG of 2 grade Ⅲ refluxing ureters at Week 52 post-operation revealed disappearing (n=1) and degrading (n=1 grade I).None of them showed any discomfort after injections.Control group:7 children with 8 ureters.There were 1 boy and 6 girls with an age range of 17-92 months.The sideness was unilateral (n=6) and bilateral (n=1).And the involved side of ureter was left (n=6) and right (n=2); the grade of reflux was Ⅱ (n=4),Ⅲ (n=3) and Ⅳ (n=1).CAP of nitrofurantoin or sulfamethoxazole was offered.For parental anxiety,two children with 2 grade Ⅲ ureters withdrew and switched to surgery.Re-examination at Week 52 indicated degrading (n=1 grade Ⅲ→Ⅰ).And the remainder were to be re-examined.Conclusion Endoscopic injection of dextranomer/hyaluronic acid is both safe and effective for children with primary vesicoureteral reflux.
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备注/Memo
收稿日期:2019-09-04。
基金项目:国家重点研发计划（编号：2018YFC1002700）
通讯作者:唐达星,Emai:tangdx0206@zju.edu.cn