1岁以下脊髓脊膜膨出患儿术前尿动力学结果分析

Preoperative urodynamic study in infants with myelomeningocele

目的：以脊髓脊膜膨出的婴儿为研究对象，进行术前尿动力学检查，评估其膀胱功能。方法2010年2月至2014年3月，本院收治脊髓脊膜膨出患儿25例，年龄45d至1个月，平均4个月，术前应用加拿大莱博瑞（Laborie）尿动力检查系统，慢速灌注充盈膀胱进行膀胱测压。结果术前尿动力检查结果：尿动力表现完全正常13例（52％）；膀胱活动活跃6例（24％）；间断排尿4例（16％）；逼尿肌不稳定2例，其中1例膀胱顺应性3 mL/cmH2 O。所有患儿膀胱容量正常，（48．3±19.8）mL。残余尿均未见明显增加，平均（3．2±4．5）mL。因膀胱活动活跃、间断排尿多见于正常婴儿，本组23例被认为尿动力结果正常，占92％。所有患儿均经手术确定脊髓脊膜膨出及脊髓栓系诊断，其中脂肪脊髓脊膜膨出15例（占60％）。结论尿动力学检查提示术前脊髓脊膜膨出的婴儿，其膀胱功能多为正常，其神经源性膀胱的损害在1岁以内多未表现出来。

Objetive To evaluate the myelomeningocele infants ’ bladder functions with urodynamic study before operation. Methods From February 201 0 to April 201 4,a total of 25 infants with myelomeningo-cele were included in this study with age from 2 months to 1 1 months old and a mean 4.0 months.Slow-fill cys-tometry examination was performed with Laborie urodynamic system before surgery. Results Urodynamic of 1 3 patients （52%）were completely normal.Hyperactivity of detrusor was found in 6 patients （24%）.Interrupt-ed voiding was found in 4 cases （1 6%）.2 patients have instable detrusor,among them 1 patient’s bladder compliance is 3 ml/cmH2 O.No obvious increase of residual urine was found in all cases and the mean is 3.2 ±4.5 ml.Because hyperactivity and interrupted voiding are thought to be normal in infants,23 patients （92%）are considered with normal urodynamic results.The diagnosis of myelomeningocele and tethered cord syndrome was confirmed after surgery.Among them,1 5 cases （60%）were diangnosed as lipomyelomeningo-cele post-operation. Conclusion Infants with myelomeningocele have normal bladder function in their first year pre-operation.