乳児期逆流防止術の検討 ―手術術式について―

Abstract

乳児期原発性膀胱尿管逆流症(VUR)に対する逆流防止術を, 5例10尿管(男児4例, 女児1例)に施行した.手術時の平均年齢は3.2ヵ月で, 術式はPolitano-Leadbetter法が2例3尿管, Amar-Paquin変法が3例7尿管であった.1例1尿管で尿管の縫縮(tailoring)を併用した.術後6ヵ月後のVCGで逆流残存を1例で認めたが, 1年後には全例でVURの消失を確認した

Febrile urinary tract infections (UTI) resulted in the admission of five infants (four boys, one girl) to Okinawa Prefectural Hospital in Miyako. The first febrile episode developed at an average age of 1.3 months. All patients underwent cystoscopy and X-ray studies to role out secondary causes for vesicoureteral reflux (VUR). All patients had high grade reflux and underwent antireflux surgery using a modification of the Amar-Paquin method or the Politano-Leadbetter method. They tolerated the procedures without any complications. No UTI recurred and VUR disappeared in one year following surgery. Early surgical intervention seems beneficial for selected infants with high grade VUR, but the surgical procedure and methods for infants, especially those with severe dilated ureter, are still controversial.