后尿道瓣膜症患儿术后排尿功能的影响因素分析

Factors influencing postoperative urinary function in children with posterior urethral valves

目的:探讨并分析后尿道瓣膜症(PUV)患儿经膀胱镜瓣膜电切术治疗后发生排尿异常的危险因素。方法:回顾性分析本院小儿外科2015年1月~2019年1月期间收治的60例PUV患儿临床资料,患儿均经膀胱镜瓣膜电切术治疗,根据术后6个月患儿术后尿动力学检查结果、临床症状分为排尿正常组(n=11)和排尿异常组(n=49)。比较两组尿动力学参数,并分析可能引起PUV术后排尿异常发生的影响因素。结果:排尿正常组逼尿肌漏尿点压力及残余尿量小于排尿异常组,膀胱顺应性及尿流率大于排尿异常组,差异有统计学意义;产前诊断、术前膀胱壁增厚和小梁增生是影响术后排尿异常的独立危险因素。结论:PUV术后排尿异常者膀胱功能及上尿路情况明显较差,产前诊断、术前膀胱壁增厚和小梁增生严重程度与术后出现排尿异常密切相关。

Objective To investigate and analyze the risk factors for urination disorders in children with posterior urethral valves(PUV)after valve electrocision via cystoscope.Methods The clinical data of 60 children with PUV who were admitted to the hospital from January 2015 to January 2019 were retrospectively analyzed.All children were treated with valve electrocision via cystoscope.According to the results of urodynamic examination and clinical symptoms at 6 months after operation,the children were divided into the normal urination group(n=11)and the urination disorder group(n=49).The urodynamic parameters were compared between the two groups and the influencing factors that may cause urination disorders after operation for PUV were analyzed.Results The detrusor leak point pressure and residual urine volume of the normal urination group were lower/smaller than those of the urination disorder group.The bladder compliance and urinary flow rate were larger than those in the urination disorder group.Prenatal diagnosis,preoperative bladder wall thickening and trabecular hyperplasia were independent risk factors for postoperative urination disorders.Conclusion The bladder function and upper urinary tract are significantly worse in patients with urination disorders after operation for PUV.Prenatal diagnosis,preoperative bladder wall thickening and severity of trabecular hyperplasia are closely related to postoperative urination disorders.