脊髓脊膜膨出患儿尿动力学改变与上尿路损害的关系探讨

The study on correlation between upper urinary tract deterioration and urodynamic changes in patients with myelomeningocele.

目的探讨脊髓脊膜膨出患儿尿动力学改变与上尿路损害的关系。方法对36例脊髓脊膜膨出患儿行泌尿系彩超、静脉肾盂造影及尿动力学检查，根据检查结果分析与上尿路损害密切相关的尿动力学危险因素。结果36例患儿中，泌尿系彩超检查提示15例存在上尿路损害，21例无上尿路损害。尿动力学检查提示上尿路损害组中逼尿肌漏尿点压（47．2±21．9）cm H3O，显著高于未损害组（15．7±9．6）cmH2O；逼尿肌漏尿点压〉40cmH2O的发生率为66．7％（10／15），显著高于未损害组中发生率0．0％（0／21）；膀胱顺应性（4．5±2．4）mL／cmH2O，显著低于未损害组（12．8±13．2）mL／cmH2O；残余尿量（137．8±99．7）mL，显著高于未损害组（32．3±36．7）mL；残余尿量≥50mL的发生率为93．3％（14／15），显著高于未损害组中的发生率19．0％（4／21）；排尿期逼尿肌反射低下或无反射的发生率为66．7％（10／15），显著高于未损害组中的发生率14．1％（3／21）。差异均具有显著的统计学意义（P〈0．05）。结论膀胱漏尿点压升高、膀胱顺应性降低、排尿期逼尿肌反射低下或无收缩以及残余尿量增多与上尿路损害关系密切；逼尿肌漏尿点压〉40cmH2O、残余尿量〉150mL、排尿期反射低下或无反射的发生可有效提示上尿路损害。

Objective To investigate the correlation between upper urinary tract deterioration（UUTD） and urodynamic changes in patients with neurogenic bladder secondary to myelomeningocele. Methods Urinary system ultrasonography, intravenous pyelography（IVP） and urodynamic studies were performed in 36 patients with myelomeningocele. Two groups were divided according to the uhrasonography and IVP results ： UUTD group and non - UUTD group. The risk factors were analyzed with SPSS statistical software. Results Ultra- sonography suggests that 15 patients had UUTD, present with pyeloureterectasis and cortical loss. The other 21 patients hadn＇ t it. The bladder compliance （BC） was significantly lower in UUTD group than those in comparison group ; The detusor leak point pressure （ BLPP ） , the incidence of BLPP 〉 40 cmH2O , the post-void residual urine volume （PVR）, the incidence of PVR ≥50 mL, the incidence of acontractile or undereontratile detrusor during the voiding phase were significantly greater in UUTD group than those in the comparison group, respectively. Conclusion＇ The increased BLPP,the decreased BC,the increased PVR and the acontractile or undercontratile detrusor during the voiding phase have a close correlation with the UUTD in neurogenic bladder patients secondary to myelomeningocele. BLPP ≥40 cmH2 O, PVR ≥ 50 mL, the incidence of acontractile or undercontratile detrusor during the voiding phase：indicate a great risk of UUTD.