神经源性膀胱伴输尿管反流的尿动力学研究

The urodynamic study of neurogenic bladder with vesicoureteral reflux

要目的：探讨有输尿管反流的神经源性膀胱（NB）患儿有或没有逼尿肌过度活动（DO）时的尿动力学差异，为临床治疗此类患者提供理论参考依据。方法：选取就诊并经影像尿动力学检查发现膀胱输尿管反流的NB患儿110例．男63例．女47例，年龄4～12岁，平均7．5岁。按照充盈期有无DO，将其分为DO组（n=32）与无DO组（n=78）。观察记录两组发生膀胱输尿管反流时的膀胱灌注量、逼尿肌压并计算发生反流时的膀胱顺应性：记录两组充盈结束时最大膀胱测压容量、最大逼尿肌压并计算充盈期膀胱顺应性，按照反流级别将其分为轻度反流（Ⅰ～Ⅱ度），重度反流（Ⅲ一Ⅴ度），分析两组的反流侧别及反流程度有无差异。结果：DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为（107．5±21．3）mL和（5．6±1．8）mL／cmH2O，无DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为（124．7±35．6）mL、（6．7±2．3）mL／cmH2O，差异均有统计学意义（P〈0．05）；两组的逼尿肌压分别为（21．7±8．3）cmH2O、（19．6±9．2）cmH2O，差异无统计学意义；DO组充盈结束时的膀胱容量与顺应性分别为（198．7±36．5）mL、（5．8±1．9）mL／cmH2O，与无DO组充盈结束时的膀胱容量（223．8±40．2）mL与顺应性（6．5±1．4）mL／cmH2O相比，差异有统计学意义（P〈0．05）；两组尿动力学检查结束时逼尿肌压分别为（35．8±7．1）cmH2O、（36．3±8．5）cmH2O，差异没有统计学意义。DO组单侧反流20例（63％），双侧返流12例（37％），无DO组单侧返流31例（40％），双侧返流47例（60％）．两组的反流程度均较严重。结论：膀胱容量小，膀胱顺应性差是有输尿管反流的NB患儿伴发DO时的尿动力学特征。

Objective In children with neurogenic bladder and secondary vesicoureteral reflux, we ex- plore the differences of urodynamies between the children with and without detrusor overaetivity （DO）. The study is in order to provide theoretical support for clinical practice. Method From January 2013 to March 2016, 110 children with NB vesieoureteral reflux diagnosed by videonrodynamics were recruited. There are 63 boys and 47girls aged 4-12 years with mean of 7.5 years. According to presence of DO during the filling phase, the patients were divided into DO （n = 32） and non-DO groups （n = 78）. The time of bladder ureter reflux perfusion and detru- sor pressure were recorded for calculation of bladder compliance when the reflux occurs in the two groups. Maximum cystometry capacity and maximum detrusor pressure were recorded for calculation of the bladder compliance at the end of filling in the two groups. According to the reflux flow level, patients were divided into mild reflux （ Ⅰ - Ⅱdegrees）, severe reflux （m-Vdegrees）. The difference of reflux side of the two groups and reflux degree were an- alyzed. Result In DO group, bladder capacity and compliance were （107.5 ± 21.3） mL and （5.6 ± 1.8） mL/ cmH2O, respectively, when bladder ureter reflux occurs. In non-DO group, the bladder ureter reflux bladder capac- ity and compliance were （124.7 ± 35.6） mL, （6.7 ± 2.3） mL/cmH2O. The two parameters were significantly differ- ent in both groups. In DO and non-DO groups, the detrusor pressure were （21.7 ± 8.3） cmH20 and （19.6 ± 9.2） cmH2O, respectively, which does not have any significant statistical difference. At the end of filling, bladder capac- ity and compliance in DO group were （198.7 ± 36.5） mL, （5.8 ± 1.9） mL/cmH2O. In non-DO group, bladder ca- pacity and compliance were （223.8 ± 40.2） mL and （6.5 ± 1.4）mL/cmH2O. In both group, there are difference. In DO group, there are 20 cases of unilateral reflux （63%） and 12 cases of bilateral reflux （37%）. In non-DO group, there are 31 cases of unilateral reflux （40%） and 47 cases of bilateral reflux （60%）. The reflux of the two groups are also serious. Conclusion Small bladder capacity and poor bladder compliance are the urodynamic charac.teris- tics of children with NB and secondary vesicoureteral reflux when DO occurs. [Key word] Neurogenic bladder; Vesicoureteral reflux; Detrusor overactivity; Videourodynamics