腹直肌转位术治疗小儿逼尿肌无反射性神经源性膀胱(附22例报告)

Enveloping the bladder with a rectus abdominis muscle flap for the treatment of children neuropathic bladder of detrusor areflexia (Report of 22 cases)

目的 :探讨小儿神经源性膀胱的手术治疗指征及疗效。方法 :对 2 2例小儿神经源性膀胱的患儿 ,经膀胱测压、尿道测压、冰水实验、膀胱造影等检查 ,确定是逼尿肌无反射 ,且不并发输尿管反流 ,尿道压力在正常范围内者行腹直肌转位术。结果 :本组 2 2例患者 ,2 0例尿失禁症状明显好转 ,能自行排尿 ,剩余尿量明显减少 ,2例尿失禁症状无改善。术后 10例测最大尿流率 >15ml/s。 4例术前肾功能中度受损患儿 ,3例术后肾功能明显改善 ,5例术前肾功能轻度受损患儿 ,4例肾功能恢复正常。结论 :此手术对于保护患儿的肾功能及提高生活质量有较好的作用。

Purpose:To evaluate the operative indication and clinical outcome for children neuropathic bladder.Methods:The total of 22 children with neuropathic bladder accepted cystometry, urethrometry, ice water test and cystography and were verified as detrusor areflexia without vesicoureteric reflux.Those patients whthin normal urethral pressure received rectus abdominis muscle transposition to envelope the bladder. Results:Of 22 cases with urinary incontinence, 20 cases can urinate by themselves, their residual urine volumes reduced apparently. The urinary flow rate was more than 15ml/s in 10 cases after operation. In 4 cases of moderate compromised renal function before operation, 3 cases improved obviously. In 5 cases of mild compromised renal function 4 cases recovered. Conclusions:This operation has a better effect on protecting renal function and lightening life inconvenience of children with neuropathic bladder. It is a viable atlernative method for children neuropahtic bladder of detrusor areflexia.