脊髓栓系综合征患儿行脊髓栓系松解术后下尿路症状与心理行为变化特征分析  

Analysis of lower urinary tract symptoms and psychological behavior changes in children with tethered cord syndrome after tethered cord release

作　　者：王文娟[1] 杨帅 周钊凯 吕磊 张艳平 文一博[2] 陆伟 王庆伟[2] 文建国[2] 杨静[4] Wang Wenjuan;Yang Shuai;Zhou Zhaokai;Lyu Lei;Zhang Yanpin;Wen Yibo;Lu Wei;Wang Qingwei;Wen Jianguo;Yang Jing(Operation Room,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;International Joint Laboratory of Pediatric Urodynamics of Henan Province&Department of Urology,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of Urology,Affiliated Xinyang Hospital,Zhengzhou University/Central Municipal Hospital,Xinyang 464000,China;Outpatient Services,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院手术部,郑州450052 [2]郑州大学第一附属医院河南省小儿尿动力国际联合实验室和泌尿外科,郑州450052 [3]郑州大学附属信阳医院,信阳市中心医院泌尿外科,信阳464000 [4]郑州大学第一附属医院门诊部,郑州450052

出　　处：《临床小儿外科杂志》2023年第3期249-253,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(U1904208);河南省医学科技攻关计划省部共建项目(SBGJ2018059)

摘　　要：目的对脊髓栓系综合征(tethered cord syndrome,TCS)患儿行脊髓栓系松解术(deterring surgery,DS)前后的下尿路症状与心理行为变化特征进行量化评估。方法收集2020年1月到2022年5月郑州大学第一附属医院经MRI诊断为TCS并接受DS的43例患儿资料进行回顾性分析。根据下尿路功能障碍症状研究网络症状指数(lower urinary tract dysfunction research network symptom index-29,LURN SI-29)和长处与困难调查问卷(strengths and difficulties questionnaire,SDQ)结果,对TCS患儿手术前后下尿路症状(lower urinary tract symptoms,LUTS)和心理行为变化特征进行量化评估。结果43例患儿手术时年龄(9.19±2.61)岁,均顺利完成随访,随访时长(9.12±6.54)个月。TCS患儿行DS前后LURN SI-29得分结果显示,术后尿失禁[25.02(4.17,66.72)分比12.51(0.00,37.53)分]、排尿困难[0.00(0.00,35.00)分比0.00(0.00,30.00)分]、尿急[0.00(0.00,24.99)分比0.00(0.00,24.99)分]单项得分以及LURN SI-29总分[24.75(15.23,41.88)分比17.14(12.38,31.41)分]的分值低于术前,差异有统计学意义(P<0.05)。术后残余尿显著减少[20(7.5,50.3)mL比11(3.0,30.0)mL],差异有统计学意义(P<0.05);手术前后心理行为异常检出率比较,情绪问题[20例(20/43,46.5%)比21例(21/43,48.8%)]、品行问题[10例(10/43,23.3%)比11例(11/43,25.6%)]、多动[14例(14/43,32.6%)比10例(10/43,23.3%)]、同伴交往问题[19例(19/43,44.2%)比15例(15/43,34.9%)]、亲社会行为[5例(5/43,11.6%)比2例(2/43,4.7%)]以及SDQ困难总分[13例(13/43,30.2%)比10例(10/43,23.3%)]差异无统计学意义(P>0.05)。结论DS能改善LUTS,但是不能改善TCS对儿童心理行为的影响,提示TCS患儿进行DS的同时应加强心理辅导和健康宣教。Objective To quantitatively evaluate the changes of lower urinary tract symptoms(LUTS)and psychological behavior in children with tethered cord syndrome(TCS)before and after tethered cord release and explore the effects of deterring surgery(DS)on LUTS and psychological behavior.Methods From January 2020 to May 2022,43 patients with TCS and DS diagnosed by MRI were retrospectively reviewed.According to the results of Lower Urinary Tract Dysfunction Research Network Symptom Index-29(LURN SI-29)and Strengths&Difficulties Questionnaire(SDQ),patient LUTS and psychological behavior changes before and after operation were quantitatively evaluated.Results 43 patients(operating age 9.19±2.61 years)completed follow-up,with an average follow-up time of(9.12±6.54)months.The paired rank sum test of LURN SI-29 before and after DS showed that postoperative urinary incontinence[25.02(4.17,66.72)vs.12.51(0.00,37.53)],dysuria[0.00(0.00,35.00)vs.0.00(0.00,30.00)],urgency of urination[0.00(0.00,24.99)vs.0.00(0.00,24.99)],and total score of LURN SI-29[24.75(15.23,41.88)vs.17.14(12.38,31.41)]were significantly lower than those before operation(P<0.05);Postoperative residual urine decreased significantly[20(7.5,50.3)ml vs.11(3.0,30.0)ml],the difference was significant(P<0.05);Comparing the detection rates of psychological behavioral abnormalities before and after surgery,emotional problems[20(46.5%)vs.21(48.8%)],conduct problems[10(23.3%)vs.11(25.6%)],hyperactivity-inattention[14(32.6%)vs.10(23.3%)],peer interaction problems[19(44.2%)vs.15(34.9%)],prosocial behavior[5(11.6%)vs.2(4.7%)],and total SDQ difficulty scores[13(30.2%)vs.10(23.3%)]were not statistically significant(P>0.05).Conclusion DS may improve LUTS.However,it cannot modify the impact of TCS on psychological behavior in children.For TCS children,nursing psychological counseling and health education should be strengthened along with DS.

关 键 词：脊髓栓系综合征 心理学 下尿路症状 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]