显性脊柱裂手术前后尿动力学对比分析  

Changes in urodynamics after repair surgery in children with dominant spina bifida

作　　者：王苹 谢向辉[1] 张潍平[1] 孙宁[1] 李明磊[1] 宋宏程[1] 焦丽丽[1] WANG Ping;XIE Xiang-hui;ZHANG Wei-ping;SUN Ning;LI ming-lei;SONG Hong-cheng;JIAO Li-li(Department of Urology,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院泌尿外科

出　　处：《中国临床神经外科杂志》2019年第8期467-469,共3页Chinese Journal of Clinical Neurosurgery

基　　金：北京市医院管理局“登峰”人才培养计划（DFL20151102）;北京市医院管理局“扬帆计划”：小儿泌尿外科（ZYLX201709）

摘　　要：目的探讨显性脊柱裂患儿手术前后尿动力学指标及临床表现的变化。方法回顾性分析手术治疗的26例显性脊柱裂患儿的临床资料,包括12例脂肪瘤型脊髓脊膜膨出、10例脊髓脊膜膨出、4例单纯脊膜膨出。术后随访3~22个月,对比手术前后泌尿系超声、尿动力学检查结果。结果术前出现下尿路症状8例,未发现肾积水;术后出现下尿路症状9例,新发肾积水2例。术后最大膀胱测定容量较术前明显增加(P<0.05);而膀胱顺应性、残余尿量、最大膀胱容量时膀胱内压、最大尿流率时逼尿肌压力均无明显变化(P>0.05)。结论显性脊柱裂术前最常见的尿动力学改变为膀胱排空异常及膀胱顺应性降低;手术前后下尿路功能障碍及短期临床表现改善不明显,需警惕远期并发症。Objective To analyze the changes in the clinical symptoms and urodynamics after the surgery in the children with dominant spina bifida in order to determine whether there is a correlation between the surgery and change in the lower urinary tract function.Methods The clinical data of 26 children with dominant spina bifida,of whom,12 suffered from lipomyelomeningocele,10 from myelomeningocele and 4 from meningocele,were analyzed retrospectively,including the clinical manifestations and outcomes of urodynamic examination before and after the surgery and so on.The repair surgery was performed in all the children in n our department from June,2016 to December,2018.Results There were lower urinary tract symptoms in 8 children,but no hydronephrosis was found in all the children before the operation.There were the lowe rurinary tract symptoms in 9 children and there was hydronephrosis in 2 children after the operation.The maximum bladder volume was significantly increased after the operation compared with before the operation(P<0.05).However,there were insignificant differences in the bladder compliance,residual urine volume,and detrusor sphincter dysfunction and detrusor pressure at the maximum urine flow rate between before and after the operation(P>0.05).Conclusions The abnormal bladder emptying and lower bladder compliance are the most common changes in the urinary dynamics before the repair surgery in the children with dominant spina bifida.There was no significant improvement in the lower urinary tract dysfunction and short-term clinical manifestation after the operation compared with before the operation.

关 键 词：显性脊柱裂 手术 尿动力学 神经源性膀胱 下尿路功能 

分 类 号：R744.9[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]