脊髓栓系综合征术后尿动力学的测定及临床意义

Urodynamic findings in tethered cord syndrome after surgery and its clinical significance

目的 探讨脊髓栓系综合征 (TCS)患儿术后尿动力学表现及其临床意义。 方法 对4 0例TCS患儿术后行尿动力学测定 ,分析影响术后下尿路症状改善及尿动力学结果的因素。 结果 4 0例患儿中 5例手术前后均无下尿路症状 ,术前 35例有尿失禁伴夜间遗尿者中术后 8例尿失禁减轻 ,2 4例无变化 ,3例加重。尿动力学测定示膀胱顺应性降低 2 1例 ,剩余尿增加 2 1例 ,逼尿肌无力19例 ,膀胱容量减小 15例 ,逼尿肌反射亢进 13例 ,逼尿肌括约肌协同失调 8例 ,漏尿点压力 >4 0cmH2 O (1cmH2 O =0 .0 98kPa) 4例。自述无下尿路症状 5例中 ,膀胱逼尿肌反射亢进 2例 ,逼尿肌括约肌协同失调 2例 ,基本正常 1例。术后尿失禁改善率原发性TCS(2 8.6 % ,8/ 2 8)高于继发性(0 % ,0 / 7,P =0 .0 4 8) ,非脂肪瘤型 (10 0 % ,3/ 3)高于脂肪瘤型者 (15 .6 % ,5 / 32 ,P =0 .0 0 4 ) ,脊膜膨出型 (36 .4 % ,8/ 2 2 )高于脊髓脊膜膨出型 (0 % ,0 / 6 ,P =0 .0 4 7) ,出生时无泌尿系症状者 (80 % ,4 / 5 )高于出生时有泌尿系症状者 (17.4 % ,4 / 2 3,P =0 .0 19)。尿动力学测定示术后原发性TCS逼尿肌反射亢进的发生率 (2 4 .2 % ,8/ 33)低于继发性TCS(71.4 % ,5 / 7,P =0 .0 15 ) ,非脂肪瘤型 (12 .5 % ,1/ 8)低于脂肪瘤型TCS(5 6 .3%

Objective To evaluate the changes of urodynamic findings in children with tethered cord syndrome (TCS) after surgery and its significance. Methods Forty children with TCS underwent urodynamic examinations.The factors affecting postoperative urodynamic findings and improvement of lower urinary tract symptoms were analyzed. Results Of the 40 children,5 had no lower urinary tract symptoms,the other 35 had incontinence before and after operation.Among the 35 children,symptoms were improved in 8,deteriorated in 3,unchanged in 24.Urodynamic studies showed decreased compliance in 21 cases,increased residual urine in 21,detrusor underactivity in 19,reduced bladder capacity in 15,detrusor hyperreflexia in 13,detrusor-sphincter dyssynergia in 8,leak point pressure >40 cm H 2O (1 cm H 2O=0.098 kPa) in 4.Among the 5 children without urinary complaints,2 had detrusor hyperreflexia,2 had detrusor-sphincter dyssynergia,and 1 was generally normal.Postoperatively the improvement of urinary incontinence rate was greater in patients with primary TCS (28.6%,8/28) than those with secondary TCS (0%,0/7;P=0.048). It was greater in patients with non-lipoma TCS (100%,3/3) than those with lipoma TCS ( 15.6%,5/32;P=0.004).It was greater in patients with meningocele TCS (36.4%,8/22) than those with myelomeningocele TCS(0%,0/6;P=0.047).It was greater in patients born without urological symptoms (80%,4/5) than those born with urological symptoms(17.4%,4/23;P=0.019).Urodynamic studies also showed the incidence of detrusor hyperreflexia after surgery was lower in primary TCS (24.2%,8/32) than in secondary TCS(71.4%,5/7;P=0.015);the incidence of detrusor underactivity was lower in non-lipoma TCS (12.5%,1/8) than in lipoma TCS(56.3%,18/32;P=0.027);decreased compliance rate was lower in meningocele TCS than in myelomeningocele TCS(100%,6/6;P=0.0052).The rates of detrusor hyperreflexia,decreased compliance and detrusor underactivity postoperatively were lower in those born without urinary symptoms (0,0/10;20%,2/10;20%,2/10) than in those with (34.89%,8/23;60.9%,14/23; 65.2%,15/23;P=0.032,P=0.031,P=0.017, respectively). Conclusions Urodynamic examinations are effective in evaluating the lower urinary tract function in children with TCS after surgery.Patients with TCS have various abnormal urodynamic findings.Pathological types of TCS and the presence of symptoms at birth influence urinary function after surgery.