回肠膀胱扩大术联合髂腰肌盆底肌加强术治疗神经源性膀胱的疗效分析  

Outcome of de-mucosalized ileocystoplasty combined with strengthened pelvic floor in patients with neurogenic bladder

作　　者：宋东奎[1] 杨松鹏[1] 吴辉[1] 张玉瑞[1] 袁璞[1] 易强[1] 王庆伟[1] 王家祥[1] 

机构地区：[1]郑州大学第一附属医院泌尿外科河南省高等学校临床医学重点学科开放实验室,450052

出　　处：《中华泌尿外科杂志》2011年第10期675-678,共4页Chinese Journal of Urology

基　　金：国家青年科学基金（30901485）

摘　　要：目的探讨去黏膜带蒂回肠膀胱扩大术联合髂腰肌盆底肌加强术治疗神经源性膀胱的疗效。方法前瞻性研究去黏膜带蒂回肠膀胱扩大联合髂腰肌盆底肌加强术治疗神经源性膀胱的疗效。神经源性膀胱患者12例。男9例，女3例。年龄18～27岁，平均25岁。临床表现为不同程度的尿失禁。病程6—64个月，平均23个月。应用超声、膀胱造影、尿动力学等检查前瞻性比较术前和术后1年的尿动力学参数，上尿路形态和肾功能情况。结果12例手术顺利。术后出现切口延迟愈合2例，肠梗阻1例，膀胱腹壁尿瘘1例，未出现黏液尿。术后1年1例因发热性泌尿系感染行自我清洁间歇导尿，11例为腹压排尿。术前膀胱输尿管反流8例，术后反流消失5例，反流程度改善3例。术前肾功能不全5例，术后血肌酐水平下降至正常范围3例。术前和术后1年最大膀胱压测定容量[（247±27）和（412±32）ml]、膀胱顺应性[（4．4±1，2）和（26．2±4．0）ml／cmH2O，1cmH2O=0．098kPa]、相对安全容量[（206±24）和（368±26）m1]、最大尿流率[（11±2）和（20±3）ml／s]、残余尿量[（136±25）和（26±8）ml]、逼尿肌漏点压[（63．1±4．9）和（17．8±3．6）cm H2O]比较差异均有统计学意义（P〈0．05）。结论去黏膜带蒂回肠浆肌层膀胱扩大联合髂腰肌盆底肌加强术可有效治疗神经源性膀胱。Objective To assess the outcome of de-epithelialied ileocystoplasty combined with strengthened pelvic floor in patients with neurogenic bladder. Methods Twelve patients （9 male, 3 feale） aged from 18 -27 years （averaged 25 years） with neurogenic bladder received de-mucosalized seromuscular ileocystoplasty combined with strengthened pelvic floor, and were evaluated by urodynamic parmeters, upper urinary tract image appearance, and serum creatinine before and one year after operation. Results After operation, the max eystometric capacity （412 ± 32 ml） , bladder compliance （26.2± 4.0 ml/H2O） , relative safety cystometric capacity （368 ± 26 ml） and max flow rate （20 ±3 ml/s） were respectively significantly higher than those preoperation （247±27 ml, 4.4 ±1.2 ml/cm H2 O, 206 ±24 ml, 11 ± 2 ml/s,P 〈 0. 05 ）. Moreover, the post voided residual （26 ± 8 ml） and detrusor leakage point pressure （17.8 ±3.6 cm H2O） were significantly lower than those of preoperation （ 136±25 ml, 63. 1 ± 4. 9 cm H2O, P 〈0.05）. The vesicoureteral reflux disappeared in five （63%） cases, and was relieved in the remaining three cases. Of the five cases with renal insufficiency, three （60%） cases had normal serum cre- atinine level, none had increased serum creatinine levels. After operation, late healing occurred in two （ 17% ） uases, intestinal obstruction in one （8%） , vesicoabdominal fistula in one （8%） , and no cases had mucous urine. Clean intermittent self-catheterization was pertormed in one case （8%） to empty the bladder due to a fever resulting from urinary tract infection, the remaining 12 （92%） cases could empty their blad- ders through abdominal pressure. Conclusions De-mucosalized seromuscular ileocystoplasty combined with strengthened pelvic floor results in a good outcome for the patients with neurogenie bladder.

关 键 词：神经源性膀胱 回肠膀胱扩大术 浆肌层 盆底肌加强术 

分 类 号：R694[医药卫生—泌尿科学]