乳幼児膀胱尿管逆流症の臨床的検討

Abstract

1) 3歳未満児は52例で, 原発性逆流が48例, 神経因性膀胱による逆流が4例であった.男女比は1:1にて, 片側逆流が多くみられた.原発性逆流では11例が保存的治療を, 37例が逆流防止術を施行された.神経因性膀胱による逆流では, 1例が保存的治療を, 3例が逆流防止術を施行された.2)保存的治療では軽度逆流のもので消失するものが少数例みられたが, 長期の経過観察がきわめて困難であった.3)逆流防止術は乳幼児期の早期施行でも重篤な合併症はみられず, 全例で逆流が治癒した.4) Politano-Leadbetter法を乳幼児に用いる場合, 腹膜損傷に十分注意する必要があり, Politano-Leadbetter変法が有用であった.5)高度腎機能低下した逆流腎は, 逆流防止術を施行しても腎機能の回復はみられなかった.6)乳幼児期でも保存的な長期観察が困難な点を留意すると, 逆流・腎障害の程度, 進行および尿路感染のコントロール等を考慮して, 早期の積極的な逆流防止術が勧められる

A clinical study was performed on 52 infants up to 2 years old with vesicoureteral reflux. We treated 12 of them conservatively. Half of them dropped out within 1 year. It was very difficult to follow up the infants over a long time in the conservative treatment group. As a result of the conservative treatment, reflux disappeared spontaneously in only 2 infants. Forty infants underwent antireflux operations. The reflux disappeared in all cases. However, we injured the peritoneum in 2 cases when the Politano-Leadbetter method was applied. A modified Politano-Leadbetter method was adopted because of the peritoneum injury. As an antireflux operation on infants, the modified Politano-Leadbetter method is desirable. Renal function and growth were studied. Renal function was assessed with 99m-Tc-DTPA renograms. Renal ratio was evaluated by intravenous pyelography. The function of refluxing kidneys Severely damaged was not improved after the antireflux operations. The small kidneys with a high grade or the atrophic kidneys did not demonstrate normalization of renal growth after antireflux operations. In conclusion, it is important to detect the reflux at the early infant stage and perform the antireflux operation at an early stage in the case of high grade or renal impairment.