脊髓脊膜膨出术后大小便失禁的手术方式选择及术后随访结果分析

Selection of operation type and anaslysis to the follow up result of Meningomyelocele postoperation fecal and urine incontience in children

目的 :探讨小儿腰骶部脊髓脊膜膨出修补术后及隐性脊柱裂所致的神经源性大小便失禁的手术方式及术后处理方法。方法 :4～ 14岁患儿 71例均表现为排尿排便异常。病理改变为盆底肌肉瘫痪 ,肌层薄弱 ,盆底下垂 ,排尿反射消失 ,膀胱容积改变。全组患儿均采用改良的双侧髂腰肌加强盆底肌 ,直肠悬吊 ,回肠去粘膜带血管蒂浆肌层补片加强膀胱逼尿肌 ,膀胱扩大成形术治疗。随访 6月～ 3年。结果 :71例中 ,大便控制明显改善 67例 ,小便控制明显改善 63例 ,8例经术后训练有改善。结论 :此方法是治疗神经源性大小便失禁的一种较好方法。术后患儿应进行排便。

Objective: To study the operation type and treatment postoperation of neurogenic fecal and urine incontinence in Children with meningomylo cele and occult celft spine.Methods: 71 cases aged 4-14 years were treated by modified rectal suspension and strenthening pelvic floor and the patch to strengthen detrusor urine of bladder,cystectasy and cystopalsyt.All of them presented disturbance of defecation.The pathological changes appeared palalysis of pelvic floor muscles.Ptosis of pelvic floor.The disapearance of micturition reflex and the change of bladder volume.The follow-up period was 6 months to 3 years.Results: in this group of 71 cases:67 cases of fecal control are improved obvionsly.63 cases of mictyrition control were improved obvionsly.8 cases were comehow improved after trained in defecation function.Conclusion: This is a good method for treatments of neurogenic fecal and urine incontynence.Training of defection function was important to the petients post operation.