神经原性膀胱的手术选择与并发症分析  

Surgical procedures of neurogenic bladder and analysis of the complications

作　　者：李守林[1] 陈维秀[1] 陈雨历[1] 李金良[1] 林芃[1] 孙大庆[1] 

机构地区：[1]山东大学第二医院小儿外科

出　　处：《中华泌尿外科杂志》2005年第7期464-467,共4页Chinese Journal of Urology

摘　　要：目的探讨神经原性膀胱手术方式选择与术后并发症。方法神经原性膀胱患儿94例,年龄3～19岁,平均9岁。表现为不同程度大小便失禁。选用术式包括①盆底肌加强,②膀胱颈悬吊,③膀胱扩大,④Malone术和⑤输尿管抗返流术。本组行手术组合为:①+②+③49例,①+②+③+④16例,①+②+③+⑤16例,①+②+⑤4例,②+⑤1例,①+②5例,③+⑤3例。术后半年评价疗效采用ICIQSF评分和尿动力学检查、IVU,并分析并发症。结果手术前后尿失禁症状评分(16.1±1.7和8.4±2.1)、实际容量与预计容量之比(0.4±0.2和1.2±0.2)、顺应性[(3.0±1.7)和(11.9±2.4)ml/cmH2O)]、充盈末期膀胱压力[(60.8±30.7)和(46.3±24.8)cmH2O],差异均有统计学意义(P值均<0.05)。术后并发症24例(25.5%),近期12例,远期12例;盆腔感染2例,会阴感染1例,尿性腹膜炎2例,肠梗阻3例,膀胱阴道瘘1例,膀胱输尿管连接处狭窄1例,膀胱腹壁瘘2例,肛瘘2例,膀胱挛缩3例,尿路感染2例,膀胱结石3例,输尿管返流2例。结论盆底肌加强、膀胱颈悬吊和膀胱扩大手术组合是治疗神经原性膀胱基本手术。术前肠道充分准备,术中严格无菌操作,操作仔细,彻底止血,术后引流充分,坚持间歇导尿是减少术后并发症的有效方法。Objective To explore the surgical procedures of neurogenic bladder and to analyze the complications. Methods This series included 94 children (age range,3-19 years;mean age,9 years) with neurogenic bladder who had fecal and urinary incontinence.The surgical procedures consisted of the following 5 types:①suspension of pelvic floor,②suspension of bladder neck,③bladder augmentation,④Malone procedure, and ⑤anti-ureteral reflux.These procedures were performed in different combinations on the 94 children.Among them,49 cases underwent ①+②+③ types;16 cases underwent ①+②+③+④;another 16 cases underwent ①+②+③+⑤;4 cases underwent ①+②+⑤;1 cases underwent ②+⑤;5 cases underwent ①+②;3 cases underwent ③+⑤.The therapeutic effects were evaluated by means of ICI-Q-SF scoring and urodynamic examination, and the complications were analyzed. Results Before and after operation,the ICI-Q-SF scores were 16.1±1.7 and 8.4±2.1;the ratios of actual to expected capacity were 0.4±0.2 and 1.2 ±0.2; the compliance was (3.0±1.7) and (11.9±2.4) ml/cm H_2O;the bladder pressure at filling end phase was (60.8±30.7) and (46.3±24.8) cmH2O,respectively. There were significant differences between the pre- and post-operative parameters (P<0.05 for all).Postoperative complications occurred in 24 cases (25.5%),including 2 cases of pelvic infection,1 of perineal infection,2 of ruinous peritonitis,3 of intestinal obstruction,1 of vesicovaginal fistula,1 of vesicoureteral conjunction stricture,2 of bladder fistula,2 of anal fistula,3 of bladder contracture,2 of urinary tract infection,3 of bladder calculi,and 2 of ureteral reflux. Conclusions Suspension of pelvic floor,suspension of bladder neck and bladder augmentation are basic surgical procedures for the treatment of neurogenic bladder. In addition, preoperative adequate preparation of intestine,intraoperative aseptic and careful manipulation,prevention of bleeding, and postoperative adequate drainage,persistent intermittent clean catheterization are

关 键 词：神经原性膀胱 并发症分析 手术选择 术后并发症 膀胱颈悬吊 尿动力学检查 大小便失禁 尿性腹膜炎 膀胱阴道瘘 膀胱输尿管 膀胱腹壁瘘 输尿管返流 方式选择 膀胱手术 不同程度 膀胱扩大 抗返流术 症状评分 手术前后 实际容量 

分 类 号：R699[医药卫生—泌尿科学]