伴排尿障碍的隐性脊柱裂患儿的尿动力学特点

Urodynamic characteristics of spina bifida occulta children with urinal dysfunction

目的研究伴有排尿功能障碍的隐性脊柱裂患儿的尿动力学特征。方法对113例有排尿障碍的患儿进行尿动力学检查，其中48例经X线确诊为隐性脊柱裂者为观察组，无脊柱裂65例为对照组。检测项目包括：尿流率测定、充盈期膀胱压力容积测定、压力一流率测定、同步括约肌肌电测定、静态尿道压力测定。比较两组间主要尿动力参数异常的发生率。观察组按主要临床症状分为尿失禁、尿频、单纯夜间遗尿和排尿困难4组，应用统计学研究临床症状与尿动力学主要参数的相关性。结果在检测中发现观察组48例中有46例有不同程度的异常。其中逼尿肌过度活动22例，排尿期逼尿肌活动低下和无收缩21例，最大尿流率降低18例，膀胱容积缩小15例，残余尿量增多12例，低顺应性膀胱7例，逼尿肌外括约肌协同失调4例，最大尿道压降低4例。观察组中逼尿肌过度活动、逼尿肌活动低下、残余尿量增多及低顺应性膀胱发生率更高。按临床症状来看，隐性脊柱裂伴有尿失禁的患儿更多的表现为逼尿肌活动低下及最大尿流率降低，尿频的患儿在尿动力检查中多表现为逼尿肌过度活动及残余尿增多，排尿困难的患儿逼尿肌活动低下的发生率更高，而遗尿的患儿更易检出逼尿肌过度活动。结论小儿隐性脊柱裂伴有排尿功能障碍的患儿具有多种尿动力学改变，且相同的症状可表现为不同类型的尿动力学异常，临床症状与尿动力学参数有一定的相关性，尿动力检查为其临床诊断和治疗方案制定提供重要客观依据。

Objective To explore the urodynamic characteristics of spina bifida occulta （SBO） children with urinal dysfunction. Methods A total of 113 patients with urinal dysfunction, 48 with SBO diagnosed radiologically and 65 negative controls were recruited. The major symptoms were incontinence, increased voiding frequency and dysuria and nocturnal enuresis. Uroflowmetry was conducted for all cases. And 112 of them received invasive urodynamic examinations for analyzing the correlation between main items of urodynamics and symptoms. Results Most （46/48） of them had various abnormalities on urodynamic test. There were detrusor instability （DI, n = 22）, detrusor underactivity （n = 21）,decreased maximum flow rate （n = 18,Qmax）, decreased bladder capacity （n = 15）, increased post-void residual urine （n = 12, PVR）, decreased bladder compliance （BC, n = 7）, detrusor-external sphincter dyssynergia （n = 4） and decreased urethral pressure （n = 4）. DI, detrusor underactivity,increased PVR and decreased bladder compliance were more often present in patients with SBO. According to the symptoms, correlation existed between incontinence and decreased Qmax and detrusor underactivity; increased voiding frequency and increased PVR; dysuria and detrusor underactivity; nocturnal enuresis and DI. Conclusions SBO children with urinal dysfunction may have various urodynamic changes. And the same clinical manifestation may have different abnormalities. And the symptoms are probably correlated with urodynamic changes.