脊髓发育不良患儿尿路功能的早期评价和处理  

Urodynamic evaluation and management of neurogenic bladders in children with myelodysplasia

作　　者：陈维秀[1] 李金良[1] 陈雨历[1] 孙小兵[1] 

机构地区：[1]山东大学第二医院小儿外科,济南250033

出　　处：《中华小儿外科杂志》2007年第8期416-418,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨早期评价和干预治疗对脊髓发育不良所致的神经原性膀胱患儿上尿路和膀胱功能的影响。方法回顾性分析1997～2003年收治的脊髓发育不良,尿流动力学显示存在膀胱高压和/或逼尿肌括约肌不协调的75例年龄在1岁以内神经原性膀胱患儿,其中30例从发现高危因素后即开始应用间歇导尿和抗胆碱能药物治疗的患儿作为研究组,随访数年,记录上尿路功能、膀胱功能及手术干预情况,与其余没有进行间歇导尿和抗胆碱能药物治疗的患儿(对照组)进行比较。结果平均随访时间6.6年(3.6～9.8年),研究组共30例患儿,在随访期间2例出现上尿路持续性扩张,2例膀胱输尿管反流,3例膀胱顺应性差,最终5例行膀胱扩大术;对照组除去7例失访,38例中18例上尿路扩张,15例膀胱输尿管反流,23例膀胱顺应性下降,26例行膀胱扩大术,上尿路损害和最终需行膀胱扩大术的病例研究组明显低于对照组。结论脊髓发育不良所致的神经原性膀胱,病理损害是逐渐加重的,如早期进行尿流动力学评价,针对高危因素早期预防性治疗对保护肾脏和膀胱功能,控制尿失禁,减少膀胱扩大术,被证实是有效的。Objective To assess the efficacy of clean intermittent catheterization and anticholinergic medication in the management of neurogenic bladders in children with myelodysplasia. Methods We reviewed the urological outcomes in 75 children with myelodysplasia. Thirty children （study group） were managed with clean intermittent catheterization and anticholinergic medication starting in the first year of life. Forty-five children （control group） received no treatment. We compared the incidences of hydronephrosis, reflux, bladder compliance and requirement for bladder augmentation between the two groups. Results Persistent hydronephrosis was significantly less frequent in the study group （2/30 or 6. 6%） than the control group （18/38 or 52. 8%）. There were significantly less reflux （2/30 or 6. 6% versus 15/38 or 39. 5%） in the study group. Poor bladder compliance was also signifi- candy less in the study group （3/30 or 10% versus 23/38 or 60. 5%）. Furthermore, the study group required fewer bladder augmentations than the control group （5/30 or 16. 7% versus 26/38 or 68. 4%）. Conclusions Clean intermittent catheterization and the anticholinergic medication conserve the bladder function in myedysplasia children with neurogenic bladders.

关 键 词：膀胱 脊髓发育不良 肾盂积水 尿失禁 

分 类 号：R726.9[医药卫生—儿科] R748[医药卫生—临床医学]