脊髓栓系综合征对上尿路的影响及其机制  

Influence of tethered cord syndrome on the upper urinary tract and its etiology

作　　者：曾健文[1] 谢克基[1] 姜粹平[1] 潘朝杰[2] 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 [2]广州市儿童医院神经外科

出　　处：《中华泌尿外科杂志》2008年第9期635-638,共4页Chinese Journal of Urology

基　　金：广东省科技计划资助项目（C31301）

摘　　要：目的探讨脊髓栓系综合征（TCS）对上尿路的影响及其机制。方法经脊髓MRI确诊的TCS患者40例。男21例，女19例。平均年龄23岁。病程1～40年。行尿液分析及中段尿培养、血肌酐（SCr）测定、泌尿系B超、IVU、膀胱造影及尿动力学检查，评价TCS对上尿路的影响。将有无SCr升高、肾积水、膀胱输尿管反流（VUR）界定为是否有上尿路损害。结果40例患者中有尿路感染17例（42．5％），SCr异常升高[（251．6±98．5）μmol／L]6例。B超检查（29例）示双肾积水、双侧输尿管上段扩张12例（41．4％）。IVU检查（30例）示肾、输尿管扩张、积水10例（33．3％），膀胱形态异常22例（73．3％），有较多憩室及小梁形成。逆行造影（22例）示VUR 17例（77．3％）27侧。31例（31／35）有残余尿（261．8±232．4）ml。33例膀胱压力容积测定示储尿期最大逼尿肌压（41．2±20．9）cm H2O（1cm H2O=0．098kPa），顺应性（22．3±18．8）ml／cm H2O。33例行压力-流率及肌电图测定示排尿期出现逼尿肌-外括约肌协同失调者16例（48．5％），逼尿肌无反射16例（48．5％），逼尿肌反射减弱13例（39．4％）。16例成人行静态尿道压力描记，最大尿道闭合压（76．1±33．1）cm H2O。20例有上尿路损害者与20例无上尿路损害者中逼尿肌顺应性分别为（9．4±7．8）和（19．3±15．8）ml／cm H2O、储尿期最大逼尿肌压分别为（43．1±21．2）和（24．0±11．9）cm H2O、残余尿量分别为（189．0±138．0）和（47．8±36．8）ml、最大尿道闭合压分别为（86．2±32．4）和（46．8士20．8）cm H2O、发生逼尿肌收缩力受损分别为20／20和9／13、发生逼尿肌-外括约肌协同失调分别为13／20和3／13，2组比较差异均有统计学意义（P〈0．05）。17例VUR者中16例发生尿路感染，5例无VUR者仅1例发生尿路感染，二者比较差异有统计学意义（P=0．003）。Objective To investigate the influence of tethered cord syndrome （TCS） on the upper urinary tract and its etiology. Methods Forty patients with TCS diagnosed by spinal MRI were enrolled in this study. There were 21 males and 19 females with mean age of 23 years old. The course of disease ranged from 1 to 40 years. Urinalysis, mid-stream urine culture, serum creatinine（SCr）, urinary system ultrasound, IVU, cystography and urodynamic study were carried out on all patients. Results Urinary tract infection was found in 17 patients and increased level of SCr was found in 6 patients （251.6 ±98.5μmol/L）. Of the 29 patients who underwent urinary system ultrasound examination, 12 cases had hydronephrosis and dilated upper ureter. Of the 30 patients who underwent IVU, 10（33.3%） had ureterectasia and hydronephrosis, 22 cases had bladder turriform or Christmas tree like deformity with diverticulum and trabeculum. Of the 22 patients accepted eystography, 17 cases had vesicoureteral reflux on 27 sides. Post-void residual （PVR） was evaluated in 35 patients and found increased in 31 cases. Cystometry had been done in 33 patients. The mean value of maximal detrusor pressure （Pdetmax） during filling phase was 41. 2 ± 20. 9 em H2O. The detrusor compliance was 22.3±18.8 ml/cm H2O. During voiding phase, detrusor-sphineter dyssynergia（DSD）was observed in 16 patients, detrusor areflexia was observed in 16 patients and detrusor underaetivity was observed in 13 patients. Resting urethral pressure profilemetry was measured in 16 patients. Maximal urethral closure pressure （MUCP） was 76. 1±33. 1 cm H2O. The upper urinary tract deterioration was de fined as increased SCr, hydronephrosis or vesicoureteral reflux. There were 20 patients diagnosed as upper urinary tract deterioration. The compliance of the upper urinary tract deteriorating group and the no-deteriorating group was 9.4 ±7.8 vs 19.3±15.8 ml/cm H2O, Pdetmax was 43. 1±21.2 vs 24.0±11.9 cm H2O, PVR 189.0±138.0 vs 47.8±36.8 ml, MUCP 86.2±32

关 键 词：脊髓栓系综合征 膀胱 神经原性 尿动力学 肾损害 

分 类 号：R744[医药卫生—神经病学与精神病学] R699.5[医药卫生—临床医学]