脊髓损伤继发肾积水的病理生理与治疗

Pathophysiology and Treatment of Secondary Hydronephrosis after Spinal Cord Injury (review)

脊髓损伤(SCI)并发肾积水可导致肾功能不全,是SCI患者晚期死亡的主要原因。SCI可引起膀胱尿道神经调节功能障碍,出现功能性梗阻,膀胱内压升高,逼尿肌无抑制性收缩频率和发生率增高,从而继发肾积水。预防和治疗肾积水的首要原则是保持膀胱低内压(储尿期<40cmH2O、排尿期<60cmH2O)。服用膀胱解痉剂与间歇导尿联合应用可治疗轻度肾积水,中重度肾积水可采用手术治疗,如膀胱壁肉毒毒素注射、括约肌切开、回肠代膀胱术等。

Hydronephrosis after spinal cord injury （SCI） may result in renal insufficiency which ranks as the most common late cause of death in SCI patients. SCI may cause vesicourethral dysfunction of nerve regulation, which in turn brings about functional obstruction, high intravesical pressure, increase of the incidence and frequency of detrusor uninhibitory constractions, leading to hydronephrosis. The paramount principle of prevention and treatment of hydronephrosis is keeping low vesical pressure （storage pressure 〈40 cm H2O, voiding pressure 〈60 cm H2O）. Oral anticholinergics combined with intermittent catheterization are the best choice for the slight hydronephrosis, urinary operations such as botulinum toxin injection into detrusor, transurethral sphincterotomy, ileocystoplasty may be needed for the moderate and severe hydronephrosis.