Cohen再植术后反流影响因素的研究

目的 通过回顾性研究Cohen术围手术期各变量值,分析影响Cohen术后反流因素.方法 回顾性研究及追踪随访2008年1月至2013年12月我院收治的原发性膀胱输尿管反流(VUR)及原发性膀胱输尿管交界处梗阻(POM)患儿,排除继发反流及梗阻患儿,设置围手术期各个变量,对各变量进行统计学分析,找寻影响Cohen术后反流因素.结果 共随访218例原发VUR及POM,排除2例术中输尿管折叠再植术,1例术后出现对侧反流,1例术侧产生梗阻并发症.共纳入研究214例,其中VUR 74例,POM 140例.平均年龄3.7岁(7个月至17岁),平均手术时间72.3 min(60～95 min),平均出血5.5ml,随访时间6～53个月.19例患儿术后产生反流的并发症,其中11例通过保守治疗好转,8例通过再次Cohen术治愈,术后无反流率91.1％,最终手术成功率96.3％.经统计学检验发现在手术年龄7个月至17岁、输尿管黏膜下埋植长度与直径比2.5～7情况下,手术成功率与性别、年龄、病种、单双侧、反流度数、裁剪、埋植长度、埋植直径、埋植长度与直径比、支架管留置时间,导尿管留置时间、术前输尿管直径、术前泌尿系感染(UTI)无关(P＞0.05);输尿管黏膜下长度与直径比以≥5与＜5分成两组,两组手术成功率也无差异(P＞0.05).结论 在7个月至17岁、输尿管黏膜下埋植长度与直径比2.5～7情况下,Cohen术后反流与围手术期各个因素无关,即在此年龄段输尿管黏膜下埋植长度与直径比≥2.5即可起到抗反流作用.

Retrospective analysis of influencing factors of postoperative reflux after Cohen's reimplantation

Objective To explore the influencing factors of postoperative reflux after Cohen's reimplantation.Methods A retrospective study was conducted for the clinical data collected from January 2001 to December 2013.All patients of primary vesico-ureteral reflux (VUR) and primary obstructive megaureter (POM) underwent primary Cohen's cross-trigonal intravesical reimplantation.Secondary VUR and ureterovesical obstruction were excluded.All parameters were analyzed.Results The clinical data were available for 218 patients undergoing Coher's procedure.Two cases of ureteral plication reimplantation,one each of contralateral reflux and vesicoureteral obstruction,were excluded.Among 214 cases,there were VUR (n=74) and POM (n=140).The mean operative age was 3.7 (7/12-17) years.The mean operative duration was 72.3 (60-95) minutes.And the mean volume of blood loss was 5.5 ml.During a follow-up period of 6-53 months,complications of reflux occurred in 19 patients.And 11 cases were managed conservatively and the remainder were cured by Cohen's re-reimplantation.The non-reflux rate was 91.1 ％ and the ultimate success rate 96.3％.At the operative age of 7 months to 17 years,the success rate of Cohen's reimplantation was not affected by gender,age,category of disease,laterality,grade of reflux,diameter of ureter,length & diameter of submucosal tunnel,duration of ureteral stent and catheter,tailoring and urinary tract infection (UTI) (P＞0.05).And the success rate of Cohen's reimplantation was not affected by ureteral length-to-diameter ratio of submucosal tunnel (range 2.5-7.0 or grouping by ≥ 5 and ＜ 5) (P ＞ 0.05).Conclusions No factor may positively affect the postoperative reflux of Cohen's at the operative age of 7 months to 17 years and ureteral length-to-diameter ratio of submucosal tunnel is 2.5-7.0.VUR may be cured if length-to-diameter ratio of submucosal tunnel is ＞2.5.