儿童功能性尿失禁的临床分类和综合治疗效果

Functional incontinence in children： review of classification and experiences of treatment

目的探讨儿童功能性尿失禁的临床分类特点并观察分析初步治疗结果。方法根据Nijman诊断分类方法对63例（男31例,女32例,年龄5～14岁,平均7岁）儿童功能性尿失禁患儿进行临床分类。患儿均进行系统行为和抗感染治疗,对初期治疗效果不理想的急迫性尿失禁患儿加用抗胆碱能药物治疗。治疗方案为奥昔布宁0．4 mg·kg^-1·d^-1,持续6个月后逐渐减量,6个月后效果不理想者改用托特罗定1～2 mg,2次／d,持续3～6个月。单纯功能性排尿障碍者采用行为治疗和盆底肌松弛训练。采用Farhat介绍的儿童功能性排尿障碍评分标准进行临床评估。结果63例中急迫性尿失禁41例,功能性排尿障碍22例。后者分别表现为Staccato排尿13例、Fractionated排尿7例、Lazy膀胱综合征2例。单纯行为治疗总有效率为急迫性尿失禁34％（14／41）,功能性排尿障碍77％（17／22）。行为治疗无效的急迫性尿失禁患儿行抗胆碱能药物治疗有效率达81％（22／27）。结论对儿童功能性尿失禁准确的临床分类是进一步治疗的重要基础,行为和药物治疗可以取得一定效果。

Objective To review the clinical classification and to report the therapeutic experiences of 63 cases functional incontinence in children. Methods Sixty-three children with functional incontinence were classified according to diagnostic classification method reported by Nijman. Treatment included behavioral therapy and anti-infective therapy in all children. Anticholinergic agents were used in children with urge syndrome and not responding to initial treatment. Results Urge syndrome was present in 41 cases. Dysfunctional voiding was present in 22 cases and could be divided into 3 forms： （1） Staccato voiding, 13 cases; （2） Fractionated voiding, 7 cases; （3） Lazy bladder syndrome, 2 cases. The effective rate of behavioral therapy was 34 % （14/41）in urge syndrome and 77% （17/22） in dysfunctional voiding. The effective rate of anticholinergic therapy was 81 % （22/27）. Conclusions A standardized classification is an important basis of clinical therapy of functional incontinence in children. Several treatments including behavioral and anticholinergic therapy appear to be effective.