单纯肠道膀胱扩大术治疗神经源性膀胱合并输尿管反流的初步结果  

Augmentation enterocystoplasty without reimplantation for patients with neurogenic bladder and vesicoureteral reflux

作　　者：罗德毅[1] 杨童欣 林逸飞[1] 王坤杰[1] 沈宏[1] 

机构地区：[1]四川大学华西医院泌尿外科,成都610041

出　　处：《中华泌尿外科杂志》2015年第2期104-107,共4页Chinese Journal of Urology

摘　　要：目的 探讨单纯肠道膀胱扩大术治疗神经源性膀胱合并输尿管反流的疗效. 方法 2008年1月至2014年1月25例神经源性膀胱合并输尿管反流患者接受单纯肠道膀胱扩大术,同期未行输尿管再植术.25例术前均接受6个月以上的药物治疗无效.神经源性膀胱的病因均为脊髓损伤.术前评估内容包括尿常规、肾功能、泌尿系超声和影像尿动力学检查.25例术前均有不同程度的输尿管反流.随访时通过影像尿动力学检查再次评估膀胱功能及输尿管反流状态. 结果 25例术后随访0.5～5.5年,平均2.2年.所有患者膀胱容量明显增加,膀胱顺应性明显改善.20例（80％）输尿管反流消失,3例（12％）明显改善,2例（8％）无任何变化.Ⅰ～Ⅲ度输尿管反流患者反流消失或改善率为89％（16/18）,而Ⅳ～Ⅴ度患者反流消失或改善率为100％ （9/9）.未发生症状性尿路感染. 结论 对于高压、低顺应性的神经源性膀胱合并输尿管反流患者,单纯肠道膀胱扩大术治疗有效,可以考虑不常规行输尿管再植.Objective To assess the outcome of vesicoureteral reflux after augmentation cystoplasty in patients with neurogenic bladder.Methods Between January 2008 and January 2014,a total of 25 patients,with a hypocompliant bladder associated with vesicoureteral reflux confirmed by video-urodynamics preoperatively,were recruited in this study.They all had undergone bladder augmentation with a generous detubularized segment of bowel at our institution.No effort had been made to correct existing reflux.Preoperatively assessment included urinalysis,kidney function tests,ultrasonography,video-urodynamic evaluation.All patients had various degrees of vesicoureteral reflux.The status of vesicoureteral reflux and bladder function were studied by video-urodynamic.Results Mean follow-up was 2.2 years （range 0.5 to 5.5 years）.The video-urodynamics manifested a significant improvement of bladder capacity,diminution of intravesical pressure and resolution of reflux after bladder augmentation.Of the 25 patients,20 （80%） no longer had reflux,3 （12%） had improvement,2 （8%） had no change.Sixteen of 18 with grades Ⅰ to Ⅲ （89%）,all refluxing units with grade Ⅳ to grade Ⅴ （100%） showed complete cessation of reflux.Symptomatic urinary infection was not found after surgery.Conclusions Augmentation enterocystoplasty without ureteral reimplantation is effective and adequate for patients with high pressure and hypocompliant neurogenic bladder.Therefore,ureteral reimplantation is not necessary underwent when augmentation enterocystoplasty is recommended to patients with neurogenic bladder and vesicoureteral reflux.

关 键 词：膀胱 神经源性 膀胱输尿管反流 膀胱扩大术 输尿管再植 

分 类 号：R699[医药卫生—泌尿科学]