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目的总结儿童原发性膀胱输尿管返流(PVUR)的诊断与治疗经验。方法回顾性分析本院近8 a来收治的36例共60侧PVUR患儿的诊治资料,其中1例先行保守治疗,保守治疗无效后行经膀胱内横向黏膜下推进抗返流输尿管膀胱再植术(Cohen手术)治疗,另外35例诊断明确尿路感染控制后均行Cohen手术治疗,术后3～6个月回院复诊,并进行尿常规、排泄性膀胱尿道造影(VCUG)、肾核素扫描等检查,观察治疗效果。结果经VCUG检查证实35例患儿术后返流消失,其中1例患儿术前双侧Ⅳ度返流、慢性肾功能不全,术后VCUG检查膀胱输尿管无返流,但肾功能无改善,并进一步恶化至尿毒症期,透析替代治疗维持生命;1例双侧患病患儿术后7 a复发,再次行Cohen手术治疗,术后6个月复查,效果良好。结论 VCUG检查是诊断PVUR的金标准,Cohen手术治疗儿童PVUR具有创伤小、并发症少、成功率高的优点,是治疗儿童PVUR的经典术式。
Objective To summarize the experience of diagnosis and treatment of primary vesicoureteral reflux (PVUR) in children. Methods The data of 36 cases of PVUR in 36 cases treated in our hospital during the recent 8 years were retrospectively analyzed. Among them, one case received conservative treatment and the other was conservative treatment. The transvaginal submucosal anti-reflux ureter bladder replantation (Cohen operation). Another 35 patients were diagnosed urinary tract infection control after Cohen surgery, 3 to 6 months after the return visit to hospital, and urinary routine, excretory urinary bladder urethra (VCUG), renal nuclide Scan and other tests to observe the therapeutic effect. The results of the VCUG examination confirmed that 35 cases of children with reflux disappeared, including 1 case of bilateral preoperative bilateral degree of reflux, chronic renal insufficiency, postoperative VCUG examination of vesicoureteral reflux, but no improvement in renal function, And further exacerbated to uremia, dialysis alternative treatment to maintain life; 1 case of children with bilateral disease recurrence 7 a after operation again Cohen surgery, 6 months after the review, the effect is good. Conclusions VCUG examination is the gold standard for the diagnosis of PVUR. Cohen surgical treatment of children with PVUR has the advantages of less trauma, fewer complications and high success rate, and is a classic operation for treating PVUR in children.