小児原発性膀胱尿管逆流の臨床的検討

Abstract

Primary VUR 64症例について検討した.手術施行群ではVURは100%消失した.化学療法群ではgrade 1では約61.5%にVUR消失がみられたが, gradeが上昇するにしたがって消失例も少なくなった.したがってgrade 3またはgrade 4では手術療法が適応と考えられるが, low grade群においても, 腎機能障害の発生や進行について注意が必要である.一側VUR症例に関して経過観察中他側に新たにVURが出現した症例はなく, 両側ともanti-reflux surgeryを行なうことに関して

The retrospective analysis of 64 patients between 1 month and 14 years old with 87 primary vesicoureteral units with reflux was reviewed. They were followed-up for a period of 3 to 60 months. Thirty one patients were managed conservatively by chemotherapy (group A) and 28 patients were treated surgically. As the anti-reflux operation the Politano-Leadbetter procedure was used in 27 patients and the modified Politano-Leadbetter procedure in 1 patient (group B). Five patients were not treated (group C). In 13 of the 30 renal units of group A, the vesico-ureteral reflux disappeared spontaneously and in group B the post-operative cystourethrography revealed cure of reflux in all the renal units. In 2 of the 21 renal units of group A excretory urography (IVP) revealed improvement and in 3 deterioration. Post-operative IVP revealed improvement in 13 of 39 renal units of group B and in 2 deterioration. In 3 of the 22 renal units of group A the renogram revealed improvement and in 3 deterioration. The post-operative renogram revealed improvement in 8 of the 28 renal units of group B and deterioration in renal units. Analysis was also made according to the vesicoureteral reflux grade.