小儿神经源性膀胱与上尿路损害

Neurogenic bladder dysfunction and upper urinary tract deterioration in children

目的 探讨脊髓发育不良致神经源性膀胱造成上尿路损害的尿动力学危险因素。 方法 对 32例脊髓发育不良患儿行尿动力学和影像学检查。 结果 18例 (5 6 % )有肾和输尿管积水 ,其中 4例伴Ⅳ～Ⅴ级膀胱输尿管返流。 19例逼尿肌漏尿点压力≥ 40cmH2 O(1cmH2 O =0 .0 98kPa)且膀胱顺应性≤ 40ml/cmH2 O的患儿中 ,17例合并上尿路损害。 13例逼尿肌漏尿点压力 <40cmH2 O且膀胱顺应性 >40ml/cmH2 O的患儿中 ,仅 1例有双侧输尿管扩张 ,差别有非常显著性意义(P <0 .0 0 1)。 结论 对脊髓发育不良致神经源性膀胱的患儿应行尿动力学检查 ,了解逼尿肌漏尿点压力和膀胱顺应性 ,确定与上尿路损害有关的危险因素 ,有助于避免上尿路进一步损害。

Objective To evaluate the risk urodynamic factors of upper urinary tract deterioration in children with neurogenic bladder dysfunction secondary to myelodysplasia. Methods Urodynamic and imaging studies were performed in 32 children with myelodysplasia. Results 18 patients had ureterohydronephrosis and 4 of them had vesicoureteric reflux.Of 19 children with detrusor leak point pressure higher than 40 cmH 2O and bladder compliance less than 40ml/cmH 2O, upper tract deterioration was revealed in 17.In contrast,of 13 patients with detrusor leak point pressure less than 40 cmH 2O and bladder compliance higher than 40 ml/cmH 2O, only one had bilateral ureteral dilatation( P <0.001). Conclusions For protection of upper urinary tract, urodynamic studies including detrusor leak point pressure and bladder compliance should be done in order to assess those risk factors responsible for upper tract deterioration.