保留膀胱黏膜肠浆肌层膀胱扩大术的尿流动力学评价

The urodynamic evaluation of bladder augmentation using de-epithelialied small intestine lined with urothelium

目的评价神经性膀胱行保留膀胱黏膜双层小肠浆肌层膀胱扩大术后的尿流动力学变化.方法45例逼尿肌反射亢进型神经性膀胱行保留膀胱黏膜的小肠浆肌层膀胱扩大术,男26例,女19例,年龄4～14岁.36例随访2年,手术前后行尿流动力学检查.结果手术后膀胱容量、膀胱顺应性、尿流率较术前增加,逼尿肌压降低,残余尿量/膀胱容量较术前减小,无抑制收缩减轻.逼尿肌括约肌不协调和尿道闭合压无改变.30例临床症状改善.结论保留膀胱黏膜的双层肠浆肌层膀胱扩大术可增加膀胱容量及顺应性,降低逼尿肌压,减轻逼尿肌反射亢进的程度,逼尿肌括约肌不协调以及尿道闭合压无明显变化.

Objective To evaluate the urodynamic outcome of bladder augmentation using deepithelialized segment of small intestine lined with urothelium in hyper-reflexia neurogenic bladder.Methods Forty-five patients with neurogenic bladder were managed with bladder augmentation usingdeepithelialized segment of small intestine lined with urothelium（age： 4-14 years, male：26 cases, female： 19 cases）. 36 cases were followed up. Urodynamic evaluation were performed before and 2 years after operation. Results After operation, the bladder volume, maximum urine flow rate and compliance increased, but residual urine volume and detrusor pressure decreased. Involuntary contraction decreased. Clinical outcomes were improved in 30 cases. Conclusions Bladder augmentation using deepithelialized segment of small intestine lined with urothelium can increase the bladder volume and compliance, but decrease the detrusor pressure and hyperreflexia. Detrusor-sphincter dyssynegia and low urethral closing pressure remained unchanged.