乙状结肠膀胱扩大术治疗神经原性低顺应性膀胱10例报告  

Management of low compliant neuropathic bladder with augmentational cystoplasty using sigmoid colon （report of 10 cases）

作　　者：谢克基[1] 汤平[1] 姜少军[1] 曾健文[1] 李涛[1] 廖土明[1] 邓向荣[1] 潘朝杰[1] 姜粹平[1] 钟惟德[1] 王良圣[1] 魏鸿蔼[1] 

机构地区：[1]广州市第一人民医院泌尿外科,510180

出　　处：《中华泌尿外科杂志》2007年第1期30-33,共4页Chinese Journal of Urology

基　　金：广东省科技计划资助项目（C31301）

摘　　要：目的探讨乙状结肠膀胱扩大术治疗神经原性低顺应性膀胱的疗效。方法采用乙状结肠膀胱扩大术治疗10例神经原性低顺应性膀胱患者。男6例，女4例。年龄4～32岁，平均16岁。病程4～20年。其中脊髓栓系综合征8例，脊髓损伤2例。术前均未接受过骶神经根切断和膀胱手术。有膀胱输尿管返流者同时作返流侧输尿管膀胱再植术。术后不能自行排尿或剩余尿量〉50ml者辅以间歇性清洁导尿。结果术后随访11～57个月。术前漏尿者10例，术后仅3例仍有漏尿，但程度明显减轻。血肌酐（SCr）由（263．8±109．8）gmol／L降至（113．1±23．2）gmol／L（P〈0．01），膀胱容量由（61．9±37．7）ml增至（373．0±88．1）ml（P〈0．01），储尿期最大逼尿肌压力由（54．2±44．8）cm H2O（1cmH2O=0．098kPa）降至（17．7±10．6）cm H2O（P〈0．01）。有膀胱输尿管返流者由9例17侧减少至1例1侧。需长期间歇性清沽导尿者4例，其中1例因末按时进行间歇性清洁导尿者导致代谢性酸中毒，按时间歇性清洁导尿后治愈。菌尿10例，其中1例需抗生素治疗。结论乙状结肠膀胱扩大术是治疗神经原性低顺应性膀胱的有效方法，能改善患者肾功能，提高患者生活质量。Objective To explore therapeutic effects of augmentational cystoplasty using sigmoid colon in patients with low compliant neuropathic bladder. Methods From May 2001 to March 2005, sigmoid colon was adopted in augmentational eystoplasty in 10 cases of low compliant neuro pathic bladder. The patients consisted of 6 males and 4 females with age ranging from 4-32 years （average 16）. The duration of the disease ranged from 4--20 years. The diagnosis of primary disease were spinal dysraphism （8 cases） and spinal injury （2 cases）. All patients had no previous rhizotomy or bladder operations history. Antireflux reimplantation of ureters was performed in the patient with reflux. For patients with dysuria or residual volume exceeded 50 ml, clean intermittent catheterization was suggested. Results Preoperatively all patients had incontinence. Serum creatinine averaged （263.8±109.8）gmol/L. Maximal bladder capacity averaged （61. 9 ±37. 7） ml. Maximal detrusor pressure during filling was （54.2 ± 44.8）cm H2O. Vesico ureteric reflux occurred in 9 cases and 17 ureters. Patients were followed up from 11 to 57 months. Three cases had persisting leakage （30%） with the severity markedly reduced. The averags serum creatinine decreased to （113.1±23.2）gmol/L （P〈0.01）. Maximal bladder capacity increased to （373.0±88. 1）ml（P〈0.01）. Maximal detrusor pressure during filling reduced to （ 17.7± 10.6） cm H2O （P〈0.01 ）. Vesieoureteric reflux occurred in 1 case unilateral. Four cases needed long-term clean intermittent catheterization. One case developed metabolic acidosis which was recovered when schedule for intermittent catheterization was applied. There were 10 cases of bacteriuria with only one case required antibiotics treatment. Conelusions Augmentational cystoplasty with sigmoid colon could be an effective therapy for low compliant neuropathic bladder according to this group of cases, The operation may improve renal function and quality of life for such patients.

关 键 词：低顺应性膀胱 神经原性 膀胱扩大成形术 乙状结肠 

分 类 号：R686[医药卫生—骨科学]