影像尿动力学评估先天性膀胱输尿管返流患儿的膀胱功能障碍  

Evaluation of bladder dysfunction in children with congenital vesical ureteral reflux through videourodynamic examination

作　　者：吕宇涛[1] 文建国[1] 黄书满[1] 任川川[1] 崔林刚[1] 张艳[1] 

机构地区：[1]郑州大学第一附属医院小儿尿动力学中心和泌尿外科,河南省高等学校临床医学重点学科开放实验室,450052

出　　处：《中华实用儿科临床杂志》2014年第17期1310-1313,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的采用影像尿动力学评估小儿先天性膀胱输尿管返流（VUR）与膀胱功能障碍的关系。方法选取2011年4月至2013年7月在郑州大学第一附属医院就诊的67例VUR患儿为研究对象。患儿经影像尿动力学、尿常规、排泄性尿路造影等检查，记录患儿尿路感染、逼尿肌过度活动、逼尿肌括约肌协同失调及VUR程度等情况，根据尿动力学表现的不同分为正常组、单纯逼尿肌过度活动组和逼尿肌括约肌协同失调组（伴或不伴逼尿肌过度活动的逼尿肌括约肌协同失调），另外按照返流级别将患儿分为低级别返流（Ⅰ～Ⅱ度）和高级别返流（Ⅲ～V度），分析膀胱功能与VUR侧别、返流程度以及尿路感染的关系。结果VUR患儿合并膀胱功能异常占73．1％（49／67例），其中膀胱过度活动症占49．3％（33／49例），逼尿肌括约肌协同失调占23．8％（16／49例）。单纯膀胱过度活动患儿多为单侧，Ⅰ-Ⅱ度返流，且较少合并尿路感染。而逼尿肌括约肌协同失调的患儿多为双侧，Ⅲ～Ⅳ度返流，且较多见尿路感染。结论影像尿动力学可以准确诊断VUR，同时对患儿膀胱功能的评估，及临床制定治疗方案提供重要参考。Objective To explore the relationship between congenital vesical ureteral reflux（VUR） and bladder dysfunction in children through videourodynamic examination. Methods Sixty-seven children with congenital VUR in the First Affiliated Hospital of Zhengzhou University from Apr. 2011 to Jul. 2013 were included, and their clinical information of urinary tract infection, detrusor activity, dysfunctional voiding and grade of VUR were recorded. All the children were categorized as normal, isolated detrnsor overactivity （DO）and dysfunctional voiding （DV） （with or without DO） according to the manifestation of urodynamic patterns, who were also divided into groups of low grade （ Ⅰ - Ⅱ） VUR or high grade （ Ⅲ- V ） VUR. Data of video-urodynamic examination, urinalysis, and voiding cystourethrogram were collected to investigate the relationship between bladder dysfunction, sides and grade of VUR and urinary tract infection. Results Totally 73.1% （49/67 cases） of children with VUR were found having bladder dysfunction, which consisted of 49.3% （33/49 cases） of DO,23.8% （16/49 cases） of DV. Children with isolated DO tended to manifest unilateral,low grade reflux（ grade Ⅰ - Ⅱ） with less urinary infection. However, children with DV, isolated or combined with DO manifest bilateral, high grade reflux （grade Ⅲ- Ⅳ） , and often with urinary infection. Conclusions Video urodynamic study is useful for evaluation of bladder function in children with VUR, which is important in management of VUR.

关 键 词：影像尿动力 膀胱输尿管返流 膀胱功能障碍 儿童 

分 类 号：R726.9[医药卫生—儿科]