神经源性大小便失禁围手术期并发症及处理

The Perioperative Complication and It's Treatment for Feces and Urine Neurogenic Incontinence

目的 探讨降低神经源性大小便失禁围手术期并发症、提高疗效的有效措施。方法 回顾性分析96例接受手术治疗的神经源性大小便失禁患者围手术期主要并发症 ,逐一分析其发生原因。结果 全组无手术死亡 ,术后并发症分别为 :会阴部髂腰肌附着部切口感染 18例 ,膀胱瘘 4例 ,泌尿系感染 2例。术后随访大便失禁 ,评价结果 :分别是 4分钟者 2 8例 ,3分者 37例 ,2分者 2 3例 ,1分、0分者各 4例 ;小便失禁评价结果分别是 :排尿间隔 30min以上者 5 8例 ,尿淋离次数减少者 30例 ,无改善 8例。结论 降低神经源性大小便失禁围手术期并发症的关键在于综合处理 ,并发症的降低有利于提高远期疗效。

Objective To investigate the effective measure reducing perioperative complications and enhancing curative effect of the feces and urine neurogenic incontinence.Methods Retrospective analysis was made for the major perioperative complications of 96 patients with feces and urine neurogenic incontinence in the perioperative treatment,the causes of complications were analysed respectively.Results There was not operative death in this series,the postoperative complications were as follows:18 cases of the perineal incision infection in the part of attachment department of iliopsoas occured,vesical fistula occured in 4 cases,urinary infection occured in 2 cases.The postoperative fouowed-up of feces and urine incontinence was evaluated as 4,3,2,1,0 score respectively,and the numbers of the patients were 28,37,23,4,4 respectively;The interval of urination exceeded 30 minutes in 58 cases,the frequency of dripping urination had reduced in 30 cases,8 cases had not improved.Conclusions The key measure of reducing perioperative complications of patients with feces and urine neurogenic incontinence was a combining treatment,it is helpful for enhancing long term curative effect by reducing perioperative complications.