腰骶部脊髓脊膜膨出并发神经源性膀胱的临床研究

Neurogenic Bladder in Lumbosacral Myelomeningocele

目的:随访、复查腰骶部囊性脊柱裂术后患儿,观察神经源性膀胱发病情况。方法:对38例行尿流动力学、排尿性膀胱尿道造影、B 超及(或)静脉尿路造影检查。结果:①脊髓脊膜膨出占囊性脊柱裂的62%,脊髓脊膜膨出并发神经源性膀胱发病率为96%;②骨质缺损≥1.5cm×1.5cm 者多为脊髓脊膜膨出(P<0.005);③共有8例上尿路功能受损者,残余尿最均≥60ml,其中4例充盈期膀胱内压力≥1.96kPa(20cm H_2O),而3例膀胱逼尿肌-尿道括约肌协同失调者全部出现膀胱输尿管返流。结论:①腰骶部囊性脊柱裂骨质缺损≥1.5cm×1.5cm 者易并发神经源性膀胱;②充盈期膀胱内压力增高、膀胱逼尿肌-尿道括约肌协同失调、残余尿量明显增多是上尿路功能受损的危险因素。

Objective:To determine the incidence of neurogenic bladder among patients with spina bifida cystica in lumbosacral region.Methods:Urodyanmic studies,voiding cystourethro- gram,B-uhrasonogram and/or intravenous urography were performed on 38 cases of spina bifida cystica.Results:1.Myelomeningocele accounted for 62% of the lumbosacral spina bifida cystica and the incidence of neurogenic bladder in myelomeningocele was 96%;2.Spinal defect more than 1.5 cm×1.5 cm was indicative of myelomeningocele(P<0.005);and 3.Eight patients with up- per urinary tract deterioration had residual urine more than 60ml.Four had filling intravesical pressure over 1.96 kPa(20 cm H_2O),3 had detrusor urinae disorder with vesicoureteral reflux. Conclusions:1.The diameter of spinal defect in cases of lumbosacral spina bifida cystica more than 1.5 cm are liable to have neurogenic bladder.2.Elevated filling intravesical pressure,detru- sorsphincter dyssynergia and high residual urine are harmful factors of upper urinary tract deterio- ration.