反射亢进型神经源性尿失禁膀胱逼尿肌中氮能神经及一氧化氮的变化对膀胱功能的影响

Influence of changes of distribution of nitric oxide synthase-immunoreactive nerve and level of nitric oxide in detrusor of bladder of hyperreflexic neuropathic urinary incontinence on bladder function

目的:研究反射亢进型神经源性尿失禁膀胱逼尿肌中氮能神经分布和一氧化氮(NO)含量的变化,探讨其对膀胱功能的影响。方法:采用免疫组化法测定反射亢进型神经源性尿失禁患儿和膀胱功能正常小儿膀胱顶部逼尿肌中一氧化氮合酶(NOS)阳性神经;利用硝酸还原法测定逼尿肌中NO的含量变化。临床对于81例4～14岁反射亢进型神经源性尿失禁患儿,采用双侧髂腰肌加强盆底肌、回肠去黏膜带血管蒂浆肌层补片的基础上,行膀胱扩大术膀胱或包裹术进行治疗。结果:反射亢进型神经源性尿失禁患儿膀胱逼尿肌中NOS阳性神经数及NO含量明显低于正常对照组(P<0.05)。对于81例患者随访6个月～7年,尿失禁症状明显改善63例、术后经严格的训练有改善的18例。但其中有两例效果稍差。结论:反射亢进型神经源性尿失禁患儿膀胱逼尿肌中氮能神经的去神经及NO含量的减少,可能是造成逼尿肌反射亢进的一个因素,采用双侧髂腰肌加强盆底肌、回肠去黏膜带血管蒂浆肌层补片加强膀胱逼尿肌基础上行膀胱扩大或包裹术是治疗小儿反射亢进型神经源尿失禁的一种较好的术式。

AIM:To investigate the change of level of nitric oxide(NO) and distribution of NO immunoreactive nerve in the detrusor of patients with hyperreflexic neuropathic urinary incontinence,and to explore the effect on urinary bladder . METHODS:The distribution of nitric oxide synthase(NOS) positive nerve in the detrusor of bladder's apex in both hyperreflexic urinary incontinence children and normal children was determined by immunohistochemical technique,and the change of NO concentration in bladder detrusor was studied by reductase of nitric acid.Totally 81 hyperreflexic neuropathic children,aged 4-14 years old were performed with bladder enlarger or capsuling operation based on double lliopsoas muscle strengthening the pelvis base muscle and ileum without vascularized seromuscular layer patch of mucous membrane. RESULTS:The number of NOS positive nerves and the concentration of NO in detrusor of hyperreflexic neuropathic bladder group were obviously lower than those in normal control group(P< 0.05). After 6 month to 7 year follow up,63 patients presented obvious improvement in urinary incontinence,and 18 patients possessed less improvement after strict exercise of postoperation,incluing 2 worse cases. CONCLUSION:The reduction of NO immunoreactive nerve and NO in bladder detrusor in patients with hyperreflexic neuropathic bladder may be one of the factors that cause hyperreflexic neuropathic urinary incontience.The bladder enlarger operation using ileum without vascularized seromuscular layer patch of mucous membrane and bladder operation with double lliopsoas muscle strengthening pelvis base muscle is an effective therapy for neuropathic urinary incontinence in children.