방광요관역류 환아에서 내시경적 요관 점막하 Dextranomer/hyaluronic acid copolymer (DefluxⓇ) 주사요법의 효과에 대한 연구
Efficacy of Dextranomer/Hyaluronic Acid Copolymer (DefluxⓇ) Injection for Vesicoureteral Reflux in Children
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목 적 : 방광요관역류에 대한 치료법으로 최근 시행되고 있는 내시경적 요관 점막하 DefluxⓇ (Dextranomer/hyaluronic acid copolymer) 주사요법의 효과에 대해 알아보고자 하였다. 방 법 : 2000년 3월부터 2006년 2월까지 경북대병원 소아과에 내원하여 일차성 방광요관역류로 진단받고 이후 비뇨기과에서 내시경적 DefluxⓇ 주사요법을 시행 받은 38명(59요관)을 대상으로 하였다. 의무기록을 통한 후향적 연구를 시행하였으며, 시술 6개월 후에 VCUG를 시행하여 방광요관역류의 치료 성공 및 호전 정도를 조사하였다. 결 과 : 대상 환아의 평균연령은 2년 7개월이었으며 남녀비는 17:21이었다. 양측성이 21명(55.3%), 일측성이 17명(44.7%)이었으며 역류를 처음으로 진단받은 뒤 평균 24개월 후에 내시경적 DefluxⓇ 주사요법을 시행 받았고 평균 주입량은 0.77 cc 였다. 시행 후 성공률은 Grade 1에서 100%, Grade 2에서 87.5%, Grade 3에서 60%, Grade 4에서 20%, Grade 5에서 16.6%였으며(r=-0.99, P=0.02), 호전률은 단계별로 각각 100%, 75%, 100%, 80%, 83% 이었다(r=-0.39, P=0.21). 즉, 방광요관역류의 단계와 호전률 사이에는 의미 있는 상관관계가 없었으나, 방광요관역류의 단계가 높을수록 성공률이 의미 있게 감소하였다. 그밖에, 방광요관역류의 진단 당시 연령, DefluxⓇ 시술까지의 시간, DefluxⓇ 주입량, 배뇨장애 유무, 변비의 유무와 성공률은 통계학적으로 의미 있는 상관관계를 보이지 않았고, 항콜린제 사용군에서 성공률이 의미 있게 낮았다. 결 론 : 내시경적 요관 점막하 DefluxⓇ 주사요법은 역류단계가 낮은 환아에서는 효과적인 치료법으로, 예방적 항생제 요법을 대신하고 개복 수술 전 단계로 시행할 만한 바람직한 방법으로 생각된다.
Abstract
Purpose : The aim of this study was evaluating the efficacy of endoscopic DefluxⓇ submucosal injection in children with primary vesicoureteral reflux (VUR). Methods : Retrospective analysis of medical record was conducted on 38 children (59 ureters) who underwent endoscopic DefluxⓇ injection due to primary VUR. Data were collected from March 2000 to February 2006. Mean infused amount of DefluxⓇ was 0.77 cc. After DefluxⓇ injection, patients were reassessed by voiding cystourethrogram (VCUG) 6 months later. Results : The success rate of endoscopic DefluxⓇ submucosal injection 6 months later by VCUG was 100% for grade 1 VUR, 87.5% for grade 2, 60% for grade 3, 26.6% for grade 4, 16.6% for grade 5, respectively and there was negatively significant correlation between success rate and grade of VUR (P<0.01). Degree of improvement of VUR by endoscopic DefluxⓇ submucosal injection was not related to age at diagnosis, time to operation, existence of voiding dysfunction or constipation and infused amount of DefluxⓇ. However, group with anticholinergics medication had significantly lower success rate than non-medication group (P<0.047). Conclusion : Endoscopic DefluxⓇ submucosal injection is effective therapy in patient with primary VUR, especially low grade VUR. It can be not only a useful substitute for prophylaxis with antibiotics, but also an effective management prior to ureteroneocystostomy in children with primary VUR.
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