脊髓损伤后并发肾积水患者的影像尿动力学特点与处理

Video-urodynamic characteristic and management of hydronephrosis in traumatic spinal cord injury patients

目的:探讨脊髓损伤后发生肾积水患者的影像尿动力学特点与处理原则,为脊髓损伤后并发肾积水的防治提供依据。方法:2002年12月至2008年6月我科对1393例脊髓损伤患者进行肾脏B超检查,发现肾积水患者169例,男157例,女12例。对这些患者进行影像尿动力学检查,分析其特点,并按其特点选择相应的处理方法。结果:肾积水占本组脊髓损伤患者的12%。5例因输尿管结石梗阻引起肾积水,影像尿动力学表现为逼尿肌过度活动伴逼尿肌括约肌协同失调,经碎石治疗后积水消失。164例因膀胱尿道功能障碍引起肾积水,其中57例有膀胱输尿管返流,107例无返流(52例为低顺应性膀胱,52例过早出现或持续逼尿肌收缩型明显协同失调,3例为输尿管壁段梗阻)。47例返流性肾积水者采用经膀胱引流处理(留置尿管或膀胱造瘘,括约肌注射肉毒毒素或括约肌切断),75例非返流性积水采用经膀胱储尿(口服抗胆碱能制剂,膀胱壁注射肉毒毒素,膀胱扩大加输尿管抗返流再植术)配合间歇导尿,肾积水均得到缓解或消失。10例有返流患者因个人意愿选择膀胱储尿配合间歇导尿,32例无返流患者因不接受间歇导尿选择膀胱引流处理,肾积水也均缓解或消失。结论:脊髓损伤后发生肾积水的患者影像尿动力学特点不尽相同,依据引起肾积水的不同机制特点进行处理可获得良好的疗效。

Objective：To discuss the video-urodynamic characteristics and management of hydronephrosis in spinal cord injury patients.Method： 1393 spinal cord injury patients were undergone renal ultrasound examination during December 2002 to June 2008,hydronephrosis was found in 169 cases they were 157 males and 12 females.The video-urodynamic examination was performed to these patients,and their characteristics and managements were reviewed and analyzed.Result：Hydronephrosis was found in 12% of the spinal cord injury patients.5 cases of hydronephrosis were caused by stone obstruction and cured by lithotripsy.Their video-uro- dynamic characteristics showed over activity and the sphincter dyssynergia of detrusor.The other 164 hydronephrosis were duo to the dysfunction of urethra,including reflux 57,hypocompliance 52,early occurring or prolonged detrusor contraction with obvious detrusor sphincter dyssynergia 52,and obstruction in ureter bladder junction 3.47 reflux and 32 non-reflux hydronephrosis were managed by bladder drainage （indwelling catheter or eystostomy,botulinum toxin injection into sphincter or sphincterotomy）,75 non-reflux and 10 reflux hydronephrosis were managed by bladder enlargement （administration of antimuscarinic drugs or botulinum toxin injection into detrusor or augmentation cystoplasty） combined with intermittent catheterization,all hydronephrosis was relieved or disappeared.Conclusion：The video-urodynamic characteristics of hydronephrosis in spinal cord injury patients is various,therefore,the management of the hydronephrosis should be based on the different mechanisms.