神经源性逼尿肌无力的神经源性膀胱行双侧髂腰肌盆底加强回肠浆肌层.docVIP

回肠浆肌层代膀胱术治疗小儿神经源性膀胱随访分析 孙忠源 张谦 汪伟 院恩萌 徐颜磊 王家祥 李泸平 范应中 李正伟 【摘要】 目的 通过对神经源性膀胱患儿进行随访分析，了解手术疗效。方法 对郑州大学第一附属医院小儿外科2000年-2008年经手术治疗有术前术后完整随访资料48例神经源性膀胱患儿病例资料进行回顾性分析：尿流动力学结果、逆行膀胱造影、手术方式及术后随访尿流动力学结果进行对比分析，了解术前、术后最大膀胱容量、排尿前逼尿肌压力、最大尿道闭合压力、残余尿量及膀胱顺应性变化，对其结果进行分析。结果 对术前术后尿流动力学检查结果进行分析比较：最大膀胱容量增加（32.55±59.51ml），排尿前逼尿肌压力降低（8.81±16.45cmH2O），残余尿量明显下降（46.77±85.92ml）,膀胱顺应性升高（5.65±11.46cmH2O）。结论 应用回肠浆肌层补片术+双侧髂腰肌盆地悬吊术治疗神经源性膀胱患儿，术后膀胱容量、膀胱顺应性明显增加，膀胱逼尿肌压力及残余尿量有效地降低，膀胱逼尿肌及括约肌协调性得到改善，尿流动力学检查可作为神经源性膀胱患儿术后长远期随访的必备检查之一，可了解患儿膀胱功能状态及有无膀胱内高压。 【关键词】 神经源性膀胱，手术治疗，疗效评价，小儿 【Abstract】 Objective Through the follow-up analysis Children with neurogenic bladder to understand the surgery efficacy. Methods To analysis the cases of neurogenic bladder in children which performed the operation from 2000-2008 in The First Affiliated Hospital of Zhengzhou University, Pediatric Surgery, With complete preoperative and postoperative follow-up data 48 cases of neurogenic bladder in the children results of urodynamics (preoperative and postoperative surgery), to understand the preoperative and postoperative maximum bladder capacity, detrusor pressure before voiding, maximum urethral closure pressure, residual urine volume and bladder compliance changes, the results were analyzed. Results The preoperative and postoperative urodynamic results were analyzed and compared: maximum bladder capacity increased (32.55 ± 59.51ml), before voiding detrusor pressure decreased (8.81 ± 16.45cmH2O), residual urine volume decreased significantly (46.77 ± 85.92 ml), bladder compliance increased (5.65 ± 11.46cmH2O). Conclusion Ileum lined patch surgery + bilateral iliopsoas basin suspension surgery in children with neurogenic bladder, bladder capacity, bladder compliance increased significantly, detrusor pressure and residual urine volume effectively reduced, the bladder detrusor and sphincter coordination improved urodynamic studies in children with neurogenic bladder can be used as long-term postoperative follow-up period must check