儿童后尿道瓣膜临床特征及术后治疗效果的回顾性分析

Retrospective Analysis of Clinical Features and Postoperative Therapeutic Effect of Posterior Urethral Valve in Children

摘要: 目的：分析儿童后尿道瓣膜临床特征、评估瓣膜切除手术治疗效果。方法：回顾性分析2015年10月26日至2021年6月18日期间于重庆医科大学附属儿童医院住院经VCUG和膀胱镜诊断为后尿道瓣膜，且行膀胱镜下瓣膜切除术的患儿，共92例，均为男性，术前均行尿常规、肾功能、VCUG、泌尿系超声等检查，分析其临床特征。术后44例患儿获得随访，随访时均复查了尿常规、肾功能、泌尿系超声、VCUG。结果：92例后尿道瓣膜症患儿就诊时临床表现最常见的是肾积水和尿路感染；在住院期间合并尿路感染的共37例，34例尿培养阳性，主要致病菌为大肠埃希菌和粪肠球菌。44例患儿获得随访，手术前肾和输尿管积水共42例，其中单侧9例，双侧33例，以双侧为主；术后肾和输尿管积水共39例(39/44)，单侧9例，双侧30例。44例患儿中有16例在术后不久临床症状消失，而且没有因为术后并发症再次手术，另外28例在术后均出现了不同程度的排尿异常，其中17例PUV患儿在第一次瓣膜切除术后进行再手术治疗，再次手术距第一次手术时间1月~77月，平均18.4月；再手术患儿中有14例行2次手术，1例行3次手术，2例行4次手术。结论：后尿道瓣膜是男性儿童中常见的下尿路梗阻原因，其对患儿的远期预后影响较大，对于明确诊断的PUV患儿应尽早手术，且瓣膜切除手术疗效确切；PUV术后应定期随访肾功能、泌尿系超声、VCUG等，根据情况做相应处理，必要时可再次手术治疗。

Abstract: Objective: To analyze the clinical features of posterior urethral valve in children and evaluate the therapeutic effect of valve resection surgery. Methods: A total of 92 male children were admitted to the Children’s Hospital affiliated to Chongqing Medical University from October 26, 2015 to June 18, 2021 and diagnosed with posterior urethral valve by VCUG and cystoscope and underwent cystoscope valve resection surgery were retrospectively analyzed. All of them underwent preopera-tive urine analysis, renal function, VCUG and urinary ultrasound. The clinical characteristics were analyzed. 44 cases of children were followed up after the operation. During the follow-up, urine analysis, renal function, urinary ultrasound and VCUG were reviewed. Results: The most common clinical manifestations were hydronephrosis and urinary tract infection in 92 patients with PUV. There were 37 cases of urinary tract infection during hospitalization, and 34 cases were positive in urine culture. The main pathogens were Escherichia coli and Enterococcus faecalis. A total of 44 children were followed up, there were 42 cases of hydronephrosis of kidney and ureter before operation, of which 9 cases were unilateral and 33 cases were bilateral. Postoperative hydronephrosis of kidney and ureter were 39 cases (39/44), 9 cases unilateral and 30 cases bilateral. 16 cases of clinical symptoms disappeared shortly after surgery, and without surgery again. However, another 28 cases appeared in all the different levels of urination abnormalities, including 17 cases of children with PUV again after the first valve resection surgery. Time interval between the first surgery were 1 month~77 months, an average of 18.4 months; 14 children underwent two operations, one underwent three operations, and two underwent four operations. Conclusion: PUV is a common cause of lower urinary tract obstruction in male children, which has a great influence on the long-term prognosis of children. It should be operated as soon as possible for children with definite diagnosis of PUV, and the therapeutic effect of valve resection surgery is definite. After PUV, renal function, urinary system ultrasound, VCUG, etc., should be regularly followed up, and corresponding treatment should be performed according to the situation, and re-operation can be performed when necessary.