神经源性膀胱尿道功能障碍患者的影像尿动力学研究  

Video-urodynamic studies on 1800 patients with neurogenic bladder

作　　者：鞠彦合[1] 廖利民[1] 李东[1] 付光[1] 梁文立[1] 熊宗胜[1] 吴娟[1] 史文博[1] 韩春生[1] 

机构地区：[1]中国康复研究中心北京博爱医院泌尿外科首都医科大学康复医学院,100068

出　　处：《中华外科杂志》2008年第20期1525-1528,共4页Chinese Journal of Surgery

基　　金：国家“十一五”科技支撑计划资助项目（2008BA150B06）

摘　　要：目的探讨各类神经源性膀胱患者的影像尿动力学特点。方法2002年12月至2008年6月间，我们对1800例神经源性膀胱患者进行了影像尿动力学检查，分析不同神经病变所致膀胱尿道功能障碍的影像学特点。结果脑卒中患者均未发现上尿路改变和反流，71％为逼尿肌过度活动（DO），60％伴括约肌无抑制性松弛，29％为逼尿肌无反射（DA）。脑外伤患者中70％为DO不伴协同失调。7例帕金森病患者均表现为DO。1170例骶上损伤患者91％为DO，83％伴逼尿肌括约肌协同失调（DSD），223例骶髓及以下损伤患者73％为DA。共有12％的创伤性脊髓损伤患者出现上尿路积水改变，4％表现为膀胱输尿管反流。脊髓发育不良患者81％表现为逼尿肌无反射，86％膀胱顺应性下降，55％有上尿路积水改变，31％出现膀胱输尿管反流。腰椎间盘突出患者92％为逼尿肌无反射，88％膀胱顺应性基本正常。糖尿病膀胱患者81％膀胱感觉减退，76％排尿期逼尿肌收缩力低下。结论不同神经病变所致神经源性膀胱尿道功能障碍的特点不同，应根据影像尿动力学检查结果选择合适的临床治疗方案。Objective To explore the Video-urodynamic characteristics of various neurogenic bladder. Methods A total of 1800 patients with neurogenic bladder were included in our study from December 2002 to June 2008. All patients underwent Video-urodynamic studies. Urodynamic data was collected and analyzed. Results Urodynamie study showed detrusor overaetivity in 71% , of which 60% with uninhibited sphincter relaxation, and acontractile detrusor in 29% stroke patients. No upper urinary tract deterioration was found in all 42 stroke patients. Detrusor overactivity without sphincter dyssynergia was found in 70% patients with head trauma. Seven patients with Parkinson disease showed detrusor overactivity,of which 3 with delayed sphincter relaxation. Detrusor overaetivity was found in 91% and detrusor sphincter dyssynergia in 83% suprasacral spinal cord injured patients. Acontractile detrusor was found in 73% patients with conus medullaris and eauda equina injury. Overall,upper urinary tract changes were found in 12% and vesicoureteral reflux in 4% spinal cord injured patients. Urodynamic study showed acontraetile detrusor in 81%, reduced compliance in 86%, upper urinary tract changes in 55% and vesicoureteral reflux in 33% patients with myelodysplasia. Most patients（92% ）with protruded lumbar disc showed detrusor areflexia. Normal bladder compliance was found in 88% patients with protruded lumbar disc. Urodynamic study showed reduced bladder sensation in 81% and detrusor underactivity in 76% patients with diabetic cystopathy. Conclusions Video-urodynamic study can provide the most detailed information about the bladder dysfunction. It is the most valuable examination before treatment of patients with neurogenic bladder.

关 键 词：膀胱 神经源性 尿动力学 影像 

分 类 号：R686[医药卫生—骨科学]