小儿原发性膀胱输尿管返流的诊断与手术治疗(附39例报告)

目的：总结小儿原发性膀胱输尿管返流（PVUR）诊治经验。方法：回顾分析PVUR39例的诊治资料,1例4月龄婴儿做膀胱造口,2例患侧及1例对侧并发肾发育异常者共做3例肾切除,1例上尿路正常者用药物治疗,余35例均行膀胱内、外的横向推进抗返流输尿管膀胱再植术。结果：35例（92％）术后效果满意,2例双侧病变者第一次手术仅做严重的一侧,术后尿内持续有脓细胞,复查时原对侧Ⅰ、Ⅱ度返流增重,经再次手术治愈。1例手术后仍不能挖掘尿路感染,经患肾穿刺造瘘后好转。结论：外科矫治PVUR（Ⅳ-Ⅴ）的手术成功率,双 侧病变一期完成双侧手术。6月龄以内的PVUR（Ⅳ-Ⅴ）应做膀胱造口,周岁后应考虑抗返流的输 尿管膀胱再植术。

Diagnosis and surgical management of primary vesico-ureteral reflux in children(report of 39 cases)

Objective To study the diagnosis and surgic al management of primary vesico-ureteral reflux in children. Method s 39 children,30 boys and 9 girls,with a mean age of 4,suffered fro m severe PVUR underwent surgical treatment including vesicostomy in 1,nephrectom y of the ipsilateral or contrala- teral kidney in 3 because of renal hypopla sia or dysplasia,and reimplantion of 55 ureters in 35 children. Resu lts Satisfactory results has been observed in 35(92%).In 2 cases of bilateral PVUR,reimplantation of the contralateral ureter was undertaken after t he first session of ureteral reimplantation on one side. Nephrostomy was underta ken in 1 becaus of uncontrolled infection after reimplantation. Conc lusions Surgical management is the treatment of choice for severe PV UR with a high successful rate.Bilateral ureteral reimplantation should be unde rtaken in one stage in cases even there was mild PVUR on one side.In young infa nts under 6 months,vesicostomy should be done first and ureteral reimplantation being done later.