MR在脊柱裂脊膜膨出患者人工反射弧手术中的应用

Clinical value of MR in spina bifida patients with neurogenic bladder and bowel treated by the artificial reflex arc

目的:探讨MR在人工反射弧术前诊断、术后随访中的应用价值。方法:对67例脊柱裂脊膜膨出修补术后大小便功能障碍的患者建立人工体神经-内脏神经反射弧,以修复膀胱直肠功能。参照尿动力学检查结果,对比研究术前、术后MR的改变。结果:67例患者MR术前检查结果均经手术证实。20例患者术后随访2年以上,17例获得控尿和自主排尿功能,其中13例患者用MR检查随访,10例膀胱功能恢复的患者MR检查与术前无明显变化,而3例膀胱功能无改善者脊髓的走行、圆锥位置较术前改变不明显,圆锥末端与周围组织瘢痕增生、脂肪堆积较术前有加重趋势。结论:在应用人工体神经-内脏神经反射弧治疗先天性脊柱裂脊膜膨出所致大小便失禁时,MR对术前诊断、手术方案制定有较高的应用价值;在术后随访时,MR对治疗失败的患者有重要参考价值。

To explore the MRI clinical value by comparing MR pre and post operative changes in the spina bifida patients with neurogenic bladder and bowel treated with the artificial somatic Central Nervous System autonomic reflex pathway procedure （abbreviation： artificial reflex arc）. Methods： All the 67 cases of spina bifida with neurogenic bladder and bowel were treated with an artificial somatic-Central Nervous System-autonomic reflex pathway procedure to gain bladder ＆. bowel control. MR and urodynamic examination were performed, during the preoperative preparation and postoperative followup, focusing on the local anatomy of operating field. Results：Preoperative MR showing of all 67 cases was confirmed by the operation findings. The first 20 patients had followedup with urodynamics for over 2 years, in which 17 patients gained bladder control in 8 to 12 months after the artificial reflex arc operation. Meanwhile, postoperative MR was studied in 13 patients. Among them, 10 patients who gained bladder and bowel control showed no remarkable MR changes, 3 failed cases showed aggressive tethered cord. Conclusions： In the clinical practice of treating the spina bifida patients with neurogenic bladder and bowel with an artificial reflex arc, MR has significant value in preoperative preparation, and also in the postoperative followup, to identify the causes of failure.