尿动力学检测在小儿膀胱横纹肌肉瘤术后膀胱功能康复中的评价及临床意义

Evaluations and clinical significance of urodynamic studies of postoperative bladder function in children with bladder rhabdomyosarcoma

目的通过尿动力学检测评价小儿膀胱横纹肌肉瘤（rhabdomyosarcoma，RMS）术后膀胱功能恢复情况，以指导临床用药及膀胱功能训练，促进膀胱功能恢复，减少并发症。方法收集2003年8月至2013年8月间收治的12例膀胱RMS患儿的临床资料及排尿日记并实施尿动力学检测，依据其检测结果指导膀胱功能训练，包括盆底肌肉训练、尿意习惯训练及指导临床用药，并对影响术后膀胱功能恢复相关因素进行分析。结果本组术后行尿动力学检查并指导膀胱功能训练，除1例复发死亡外，11例中膀胱控尿功能良好9例，白天排尿间隔时间1～3h，夜间排尿0～2次；压力性尿失禁1例，白天排尿间隔时间30～40min，夜间排尿2～3次；另1例尚在膀胱训练治疗中。最后一次尿动力学检测见膀胱内压、最大膀胱测压容量、残余尿量、尿流率、膀胱顺应性均正常9例；1例术后伴压力性尿失禁，通过膀胱功能训练，现最大膀胱测压容量约135ml，为最小膀胱容量估计值的90％，而残余尿量、膀胱内压、尿流率未见明显异常，膀胱控尿功能有所改善；另1例术后6个月，最大膀胱测压容量偏小，膀胱顺应性偏低，正进行膀胱功能训练。结论膀胱RMS患儿术后，虽使用化疗药物，但膀胱功能未受到明显不利影响；尿动力学检测能准确评价膀胱RMS术后膀胱功能恢复情况，用于指导术后膀胱功能训练及用药，对促进术后膀胱功能的康复具有重要的临床意义。

Objective To evaluate the postoperative bladder function by urodynamic studies in children with bladder rhabdomyosarcoma （RMS） so as to guide the clinical rational drug use, facilitate the training of bladder function, promote the recovery of bladder function and reduce the complications. Methods The voiding diary and clinical data of 12 children patients with bladder RMS were collected and urodynamic studies performed from August 2003 to August 2013. According to the urodynamic results, bladder function training was conducted, including pelvic floor muscle and toilet training. The relevant influencing factors of bladder function were analyzed. Results A total of 12 children with bladder RMS was treated and postoperative urodynamic studies were performed routinely. Except for one mortality, the remainder had event-free survival. Urinary continence was preserved in 9 cases with diurnal urination intervals between 1-3 hours and nocturnal urination at 0-2 times. Stress urinary incontinence occurred in 1 patient with diurnal urination intervals between 30-40 min and nocturnal urination at 2-3 times. The last one received bladder function training. The final urodynamic results, including bladder pressure, maximum cystometric capacity （MCC）, residual urine volume,flow rate and bladder compliance of 9 cases were all normal after the final chemotherapy course. One case of stress urinary incontinence improved by bladder function training. MCC was approximately 135 ml （90 % of minimal calculated bladder capacity） and residual urine volume, bladder pressure and flow rate were all normal. MCC and bladder compliance decreased in one child for 6 months after operation and the child underwent training. Conclusions After operation, there is no obvious adverse effect on bladder function in children with bladder RMS on chemotherapy. Urodynamic studies may accurately evaluate the postoperative bladder function, guide functional training and clinical medication and improve bladder function.