关键词: 保守治疗, 手术治疗, 小儿膀胱输尿管反流, 疗效, 适应证

Abstract: Objective:To investigate the efficacy and indications of conservative and surgical treatment of vesicoureteral reflux in children.Methods:One hundred patients with vesicoureteral reflux in our hospital from June 2016 to June 2018 were enrolled in the study.They were randomly divided into a conservative group（50 cases）and a surgical group（50 cases）.At the same time，according to the different reflux grades of the children，the two groups were subdivided into the conservative mild to moderate group（26 cases），the operation mild to moderate group（22 cases）and the conservative severe group（24 cases）and the surgical severe group（28 cases）.The conservative group was treated with conservative（antibiotic treatment and pelvic floor muscle training），〖JP〗and the operation group was treated with laparoscopic ureteral bladder replantation.The therapeutic effects of different treatments and the urodynamic parameters before and after treatment were compared.The incidence of complications was compared between the two treatments.Results:The effective rate of conservative mild and moderate group was 84.62% and 90.91%，respectively（P>0.05）.The effective rate of severe operation group（92.86%）was significantly higher than that of conservative severe operation group（58.33%）P<0.05）.There was no significant difference in urodynamic indexes between the conservative mild and moderate group before treatment，the operation mild and moderate group，the operation severe group and the operation severe group（P>0.05）.The maximum urinary flow rate of the conservative mild to moderate group befor and after treatment were（13.25±6.30）ml/s to（7.34±5.89）ml/s，the maximum bladder volume were（209.82±86.94）ml to（141.36±51.08）ml，which was significantly increased（P<0.05）；the residual urine volume were（14.59±12.17）ml to（84.27±77.24）ml，which was significantly reduced after treatment（P<0.05）.The maximum urinary flow rate of the operation mild to moderate group befor and after treatment were（13.17±6.28）ml/s to（7.41±5.92）ml/s，and the maximum bladder volume were（215.69±87.56）ml to（142.75±51.12）ml，which was significantly increased（P<0.05），and the residual urine volume was（13.28±11.83）ml to（84.03±77.16）ml，which was significantly decrease（P<0.05）.The maximum urinary flow rate of the severe operation group and conservative severe group was（12.93±5.96）ml/s and（7.84±5.85）ml/s，the maximum bladder capacity were（209.36±88.17）ml and（139.58±75.49）ml，the residual urine volume were（19.37±16.70）ml adn（41.29±21.58）ml，the differences between the two groups were statistically significant（P<0.05）.The conservative group and operated groups with recurrent urinary tract infection（16% vs.44%）and ureteral obstruction（8% vs 36%）were significantly lower than the surgical group，the incidence of antibiotic resistance（72% vs.16%）was statistically significant which compared with the operation group（P<0.05），there was no significant difference in the incidence of renal dysfunction（24% vs.32%）and renal scar formation（20% vs.12%）（P>0.05）.Conclusion:Conservative and surgical treatment of vesicoureteral ureteral reflux have advan：tages.For mild to moderate children，conservative treatment is recommended.For severe children，surgical treatment is better.

Key words: conservative treatment, surgical treatment, vescioureteral reflux, efficacy, indications