儿童膀胱输尿管反流复发：内窥镜注射仍是最佳选择吗？

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-08-31 Epub Date: 2024-08-26 DOI:10.21037/tau-24-76

Francesca Nascimben, Isabelle Talon, Consuelo Maldonado, Rossella Angotti, Francesco Molinaro, Raphael Moog, Francois Becmeur

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引用次数: 0

摘要

背景：内镜注射（EI）是治疗儿童膀胱输尿管反流（VUR）的一种安全方法，但复发率并不低。本研究旨在说明，即使出现复发，多次内镜注射是否仍是最佳的一线治疗方法：方法：纳入所有接受过至少一次 EI 治疗且随访至少 5 年的原发性 VUR 患者。对所有一般数据进行分析。结果：共有 161 名患者（总人数）接受了 EI 治疗：161 名患者（总人数 = 210）在注射 1 次后痊愈，28 人在注射 2 次后痊愈，4 人在注射 3 次后痊愈，总体成功率为 91.90%。3 岁以上、IV 级和 V 级反流的患者复发率较高。即使 67.7% 注射一次后复发的 VUR 是无症状的，但多次 EI 后复发的诊断主要是放射学诊断。只有 8% 接受过 EI 的患者需要进行抗反流手术：结论：由于费用低廉且复发率可接受，应建议将脱流 EI 作为治疗 VUR 患儿的首选方法，尤其是低度和中度 VUR 患儿。只有年龄大于 1 岁、患有高级别 VUR（IV 级无症状和 V 级）的儿童才禁忌多次注射。

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Recurrence of vesico-ureteral reflux in children: is still the endoscopic injection the best option?

Background: Endoscopic injection (EI) is a safe treatment for vesico-ureteral reflux (VUR) in children, but recurrences are not insignificant. This study aims to show if multiple EI is still the best first line management even if in case of recurrences.

Methods: All patients affected by primary VUR, treated with at least one EI and with at least 5 years follow up were included. All general data were analyzed. Recurrence rate after one, two and three EIs were calculated.

Results: One hundred and sixty-one patients (total number =210) were healed after 1 injection, 28 after 2 and 4 after 3 with a global success rate of 91.90%. Recurrence rate is higher in patients older than 3 years old and with IV and V reflux grade. Even if 67.7% of recurrent VUR after one injection was symptomatic, diagnosis of recurrences after multiple EI was mainly radiological. Only 8% of the patients underwent EI need an anti-reflux surgery.

Conclusions: Thanks to its low costs and the acceptable recurrence rate, Deflux EI should be proposed as the first therapeutic approach for children affected by VUR, especially in those with low and moderate grades of VUR. Multiple injections could be contraindicated only in older children thank 1 year with high-grade VUR (IV symptomatic and V grade).

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.