Invance悬带术治疗儿童神经原性括约功能障碍性尿失禁(附二例报告)

Invance sling in treating children incontinence as neurogenic sphincteric incompetence (report of 2 cases)

目的 评价Invance悬带术治疗儿童神经原性括约功能障碍性尿失禁的临床效果。 方法 采用Invance悬带术治疗 2例先天性脊髓发育不良所致神经原性尿失禁患儿。 2例均为男童 ,年龄分别为 10、9岁。 结果 2例术后排尿可控 ,分别随访 12、14个月 ,尿控满意 ,每 2～ 4h排尿 1次 ,日间偶有尿失禁 1～ 2次 ,不用尿垫。夜间无尿失禁。患儿术前最大膀胱容量分别为 16 3及 2 2 3ml,术后分别为 16 4及 2 30ml;术前逆行最大尿道压 (逆行漏点压 )分别为 37及 2 7cmH2 O ,术后分别为4 5及 37cmH2 O ;术前最大尿道关闭压分别为 37及 2 6cmH2 O ,术后分别为 4 0及 37cmH2 O ;术前功能性尿道长度分别为 2 .5cm及 3.0cm ,术后分别为 3.5cm及 4 .0cm ;术前膀胱剩余尿分别为 4 0及 30ml,术后为 6及 2 5ml。术后膀胱尿道造影显示尿道球部于悬吊处受压变窄。 结论 悬带治疗儿童神经原性括约功能障碍性尿失禁简单、创伤小、可提高尿道阻力和控尿能力 ,具有特定的适应证 ,可慎重开展。

Objective To evaluate the clinical effectiveness of the Invance sling in treating children incontinence caused by neurogenic sphincteric incompetence. Methods Two children were treated with Invance sling for their neurogenic sphincteric incompetent incontinence because of congenital myelodysplasia.Both were male,aged of 9 and 10,respectively. Results Two patients were followed up of 12 and 14 months.Both patients micturated once each 2～4 hours with 1～2 episode of incontinence by chance in the daytime and without urinary pad.The maximum bladder capacities were 163 ml and 223 ml pre-operatively and those were 164 ml and 230 ml post-operatively,the retrograde maximum urethral pressures or retrograde leak point pressures were 37 cmH_2O and 27 cmH_2O pre-operatively while those were 45 cmH_2O and 37 cmH_2O post-operatively,maximum urethral closing pressures were 37 cmH_2O and 26 cmH_2O pre-operatively while those were 40 cmH_2O and 37 cmH_2O post-operatively,the functional urethral lengths were 2.5 cm and 3.0 cm pre-operatively while those were 3.5 cm and 4.0 cm post-operatively,the post-voiding residual urine volumes were 40 ml and 30 ml pre-operatively while those were 6 ml and 25 ml post-operatively.Post-operative voiding cystourethrography demonstrated that it was pressed to narrow at the suspended in the bulbous urethra segment. Conclusions The sling in treating children neurogenic sphincteric incompetent incontinence is simple,mini-invasive.It can increase the urethral resistance and continence better.But it has specific indication and should be applied prudently.