乙状结肠膀胱扩大术治疗神经原性低顺应性膀胱的疗效观察

The efficacy of bladder augmentation with sigmoid colon for patients with low compliant bladder caused by tethering spinal cord

目的探讨乙状结肠膀胱扩大术治疗神经原性低顺应性膀胱的疗效。方法对9例（男7例,女2例）脊髓栓系所致神经原性低顺应性膀胱患者行乙状结肠膀胱扩大术及自家清洁间歇导尿。患者年龄（14．2±7．3）岁,术后平均随访（39．3±37．5）个月,随访评估项目包括B超、IVU、膀胱输尿管返流造影、尿动力学、实验室生化全项检查及生活质量评估。结果9例均获随访,均未见肾积水和生化全项异常。2例患者出现一侧轻度膀胱输尿管返流。尿动力学检查示平均膀胱容量（486．7±50．0）ml,充盈期末膀胱内平均压力（18．3±5．6）cm H2O（1 cm H2O=0．098 kPa）。9例患者均能掌握自家清洁间歇导尿术,不影响患者的生活和工作。患者顽固性便秘症状消失,7例男性患者勃起功能保留。结论乙状结肠膀胱扩大术能有效增加膀胱的安全容量,消除顽固性便秘及保留男性勃起功能,结合自家清洁间歇导尿可获得良好的生活质量,是治疗脊髓栓系所致神经原性低顺应性膀胱的良好选择。

Objective To evaluate the effectiveness of bladder augmentation with sigmoid colon for patients with low compliant bladder caused by tethering spinal cord. Methods Nine cases from 1998 to 2006 were included in this study, and patients＂ mean age was （14. 2±7. 3）years（7=28 years）, the mean follow-up time was （39.3±37.5）months（6 months-8 years）. The evaluation items included sonography for bilateral kidneys, IVP, cystography, urodynamics, biochemistry and the evaluation of quality of life. Results There was no hydronephrosis and abnormal chemistry during follow-up. Two cases showed mild unilateral ureteral reflux. Urodynamics showed that the average bladder capacity was （486.7±50.0）ml（390-550 ml）, the average bladder pressure at the end of filling phase of cystometry was （18.3±5.6）cm H2O（15-30 cm H2O）. All 9 patients could manipulate clean intermittent self-catheterization, and their complaint of retractable constipation disappeared postoperatively. Seven male patients also claimed normal erectile function postoperatively. Conclusions Bladder augmentation with sigmoid colon for patients with low compliant bladder caused by tethering spinal cord not only increases the bladder safe capacity, cures retractable constipation and retains the erectile function for male patients, but also has good quality of life with clean intermittent self-catheterization. Bladder augmentation with sigmoid colon can be a good option for patients with low compli ant bladder caused by tethering spinal cord.