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中華民國泌尿科醫學會雜誌

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篇名 Ureteroneocystostomy without Ureteral Stent in the Management of Primary Vesicoureteral Reflux
卷期 8:2
並列篇名 未放置輸尿管導管的輸尿管重植手術,術後結果分析
作者 鄭鴻琳邱元佑
頁次 78-81
關鍵字 膀胱輸尿管尿迴流輸尿管導管輸尿管重植手術vesicoureteral refluxureteroneocystostomyureteral stentureteral strictureTSCI
出刊日期 199706

中文摘要

從1994年4月至1996年11月,共有23位患者,41單位輸尿管,因原發性膀胱輸尿管尿迴流,接受輸尿管重植手術。手術方法:雙側性迴流者,18位患者,採用Cohen的方法;單側性迴流者,5位,採用Politano及Lead-better的方法。年齡從2個月大至8歲大不等。迴流分期為:第五級,16單位;第四級,12單位;第三級,12單位。手術適應症:嚴重尿迴流,重覆性感染及新腎結疤現象;1單位因原先迴流,術後輸尿管阻塞及對側第三級尿迴流。所有患者,術後都未放置輸尿管導管,追蹤2至33個月(平均15.3個月)。40單位(97.6%)手術成功。雙側性患者中,1位 (6%)術後2天內,發生尿量減少及腎功能變差的現象。8單位 (19.5%)術後2個月超音波檢查發現腎水腫,但經4個月的追蹤,則已改善。 由這些重植手術的經驗,術後未放置輸尿管導管,並不會明顯增加輸尿管狹窄的機會。術後因輸尿管水腫,造成的尿量減少,將會自動減緩。不過長期腎水腫現象,就必須密切地追蹤。

英文摘要

We analyzed 23 consecutive children with primary vesicoureteral reflux (VUR), who underwent ureteral reimplantations with Cohen’s procedure or Politano-Leadbetter’s procedure between April 1994 and November 1996. Totally 41 ureteral units were assessed, including 18 patients with bilateral reflux and 5 patients with unilateral reflux, aged from 2 months to 8 years. The severity of reflux was grade V, 16 units; IV, 12 units; III, 12 units. One patient was with unilateral grade III reflux and contralateral ureteral obstruction for previous ureteral reimplantation. None of them had ureteral stent left after ureteroneocystostomy. Follow-up period was from 2 to 33 months. Of them, 40 units (97.6%) were successful. Eight units (19.5%) were found with hydroureter when followed in 2 months, but no more in 4 months. Of 18 patients with bilateral VUR, 1 (6%) was found decreased urine output and renal function deterioration in the first two days after surgery, and it resolved spontaneously. From our experience without ureteral stenting after ureteroneocystostomy, the risk of ureteral stricture did not increase. The immediate complication of decreased urine output due to relative edema subsided spontaneously. However, persistent hydroureter should be followed closely.

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