腰骶椎管脊髓病变致神经原性排尿功能障碍的诊治

Neurogenic bladder caused by latent lumbosacral vertebral canal and spinal cord diseases

目的 :探讨腰骶椎管脊髓病变致神经原性排尿功能障碍的诊断和治疗。方法 :对 2 1例患者作下尿路动力学检查和腰骶椎管磁共振成像 (MRI)检查 ,按病因进行手术治疗。结果 :发现脊髓栓系综合征 (TCS) 14例 ,椎管内肿瘤 2例 ,椎管内骨软骨瘤、神经鞘瘤和脊髓血管畸形各 1例 ,腰椎间盘突出 2例。术后随访 5～ 36个月 ,排尿恢复正常 6例 ,好转 9例。结论 :对不明原因的下运动神经原性膀胱患者应行腰骶椎管检查 ,磁共振成像是较好的检查方法 ;对腰骶椎管脊髓病变致神经原性排尿功能障碍患者应早期手术治疗。

Purpose:To study the diagnosis and treatment of Neurogenic bladder caused by latent lumbosacral vertebral canal and spinal cord diseases.Methods:21 cases received urodynamic studies and lumbosacral vertebral canal MRI and then treated by etiological operation.Results:There were 14 cases of tethered cord syndrom (TCS) and accompanied with myelomeningocele in 7 cases, lumbosacral vertebral canal lipoma in 5 cases, hamartoma and double spinal cord deformity in 1 case respectively, intraspinal cord tumor in 2 cases. The urination recovered normal in 6 cases and improved in 9 cases during 5～36 months of follow up after operation. Residual urine of bladder return to normal in 8 cases by B ultrasonography. Conclusions:It is necessary for the unknow cause neurogenic bladder patients to have MRI in order to find out the underlined pathogen. Neurogenic bladder caused by latent lumbosacral vertebral canal disease must be treated early with etiological operation.