儿童膀胱直肠功能障碍的治疗进展

Progress in treatment of bladder and bowel dysfunction in children

儿童膀胱直肠功能障碍(BBD)是指解剖及神经系统正常的儿童出现同时合并排尿、排便异常的一种疾病。BBD常合并膀胱输尿管返流(VUR)、反复泌尿系感染(UTIs),严重者导致肾脏瘢痕形成甚至肾衰竭。排尿排便管理是BBD最重要的治疗手段。经过6个月的排尿排便管理联合生物反馈法,BBD症状无改善者,可考虑药物治疗。近年来,神经电刺激、膀胱肌内注射肉毒素等治疗手段显示了良好的应用前景。

Bladder and bowel dysfunction（BBD）is a combination of bladder and bowel disturbances characterized by lower urinary symptoms and bowel dysfunction seen in children who have no identifiable or recognizable neurologic and anatomical abnormality.BBD is commonly associated with vesicoureteral reflux（VUR）and recurrent urinary tract infections（UTIs）,which ultimately may lead to renal scarring even kidney failure.Urotherapy and constipation management is an important therapy for BBD.Pharmacological therapy must only be considered if no improvement occurs after six months of urotherapy and constipation management combined with biofeedback.Recently,electroneurostimulation（ENS）and minimally invasive treatment with onabotulinumtoxin bladder injections are promising alternatives for the management of BBD.