肠浆肌层膀胱扩大术治疗神经原性膀胱的临床应用

The use of seromuscular enterocystoplasty combined with detrusorotomy in children with neuropathic bladder

目的 报告逼尿肌切开双层肠浆肌层膀胱扩大术治疗神经原性膀胱的临床应用。方法 1986～ 1999年间治疗脊髓发育不良所致的反射亢进性神经原性膀胱 5 2例 (年龄 4～ 18岁 ) ,通过随访比较手术前后临床表现和尿流动力学检查 ,评价其疗效。结果 43例随访 3个月～ 13年 ,平均6 .7年。术前均表现为尿失禁 ;术后均无粘液尿、电解质失衡、代谢紊乱、尿路结石等 ,2 4例 (5 5 .8% )能完全自主排尿 ,15例 (34 .9% )配合CIC可达到不失禁 ,有效率达到 90 .7% (39/4 3)。 39例手术前后行尿流动力学检查 ,其术前膀胱容量为 (15 9± 78)ml ,膀胱容量差为 (- 145± 6 7)ml ,充盈期末逼尿肌压为 (6 .5± 2 .6 )kPa ;术后分别改变为 (34 6± 86 )ml、(12± 5 2 )ml、(2 .1± 1.5 )kPa。均较术前有显著改善 (P <0 .0 1) ,已达到或接近其正常范围。

Objective The results and experience in bilaminary seromuscular enterocystoplasty combined with detrusorotomy were reported.Methods Between 1986 and 1999, the procedure was performed on 52 children (aged 4-18 years) with hyper-reflexic neuropathic bladder resulting from myelodysplasia. The treatment results were evaluated on the basis of clinical presentation and urodynamic valuation.Results 43 out of 52 children were followed-up for 6 months -13 years (mean time 6.7 years). Before surgery, all of them were incontinent. After surgery, 24 cases ( 55.8%) of them were fully continent; 15 cases ( 34.9%) were also continent when CIC was used. 4 cases were still incontinent. Urodynamic valuation was performed on 39 children. Preoperatively, the bladder capacity was (159±78)?ml; the decreasing bladder capacity was (-145 ?ml; the end-filling detrusor pressure was ( 6.5± 2.6)? kPa. After operation, they were (346±86)ml, (12±52)?ml and ( 2.1± 1.5)?kPa respectively, with all the paramenters being improved significantly (P< 0.01) and reaching the normal capacity and pressure for children. Conclusions Bilaminarly seromuscular enterocystoplasty combined with detrusorostomy is a good and effective method for bladder augmentation for children with hyperreflexic neurogenic bladder.