膀胱颈成形术治疗原发性尿失禁患儿的疗效观察

Bladder neck reconstruction for treatment of primary urinary incontinence in girls

目的：探讨膀胱颈成形术治疗原发性尿失禁患儿的临床经验和疗效。方法：2006年4月-2013年6月采用膀胱颈成形术治疗女性原发性尿失禁患儿10例,其中8例患儿施行膀胱颈折叠成形术（2例延期再行膀胱颈折叠和膀胱颈悬吊术）,2例行Young-Dees-Leadbetter术。结果：10例患儿术后恢复顺利,无并发症发生。术后随访6-24个月（平均14个月）,8例行膀胱颈折叠成形术的患儿中,6例术后控尿满意,一般能达到间隔2-3小时排尿,夜间排尿1-2次,无尿失禁、排尿困难、尿路感染、上尿路积水等并发症;另2例膀胱颈折叠术后仍出现尿失禁,1年后行膀胱颈折叠加悬吊术,尿失禁缓解。2例行Young-Dees-Leadbetter的患儿术后早期排尿次数较频,3个月后尿频现象减轻,无排尿困难。5例膀胱颈折叠术患儿术后5-6个月的尿动力学检查结果显示平均尿流率为（6.5±2.13）ml/s（4-9ml/s）,平均最大尿流率为（9.2±1.64）ml/s（7-11ml/s）,最大膀胱测压容量为60-140ml,膀胱顺应性良好。结论：膀胱颈折叠联合膀胱颈悬吊术方法简单,恢复较快,并发症少,有再次手术补救余地,对原发性尿失禁患儿疗效较满意。

Objective：To explore the clinical application and therapeutic efficacy of bladder neck reconstruction for treatment of primary urinary incontinence in girls.Method：Records of ten girls with primary urinary incontinence who have been treated at West China Hospital from April 2006 to June 2013 were reviewed.The mean age was 6（range,4-10）years old.Eight of them were treated with the bladder neck folding procedure（including two cases of delay line and bladder neck suspension also）,while the other two cases received Young-Dees-Leadbetter routine surgery.Result：All the patients recovered well without complications.They were followed up for 6-24（mean,14）months.Six cases who had received bladder neck folding procedure,could completely control their urinating.They urinated every 2-3hand 1-2times at night without incontinence,dysuria,urinary tract infection,hydronephrosis and other complications.However,two cases treated with bladder neck folding procedure were found incontinence.Consequently,bladder neck folding procedure combined with bladder neck suspension was performed one year later to completely control the incontinence.On the other hand,frequent urination was observed in the other two cases treated with Young-Dees-Leadbetter routine surgery early after the operation.However,frequent urination relieved three months later.The urodynamics analysis of five cases with bladder neck folding procedure in 5-6months postoperatively showed that the average flow rate was（6.5±2.13）ml/s（4-9ml/s）and the maximum flow rate was（9.2±1.64）ml/s（7-11ml/s）,the maximum cystometric capacity was 60-140 ml,and the bladder compliance was intact.Conclusion：Bladder neck folding combined with bladder neck suspension for primary urinary incontinence is an effective,easy-to-operate procedure with fast recovery and few complication.Moreover,it can be remedied if first-stage operation fails.