回肠浆肌层膀胱扩大术联合直肠悬吊术治疗小儿神经源性膀胱的效果  

Effects of Bladder Augmentation Using Seromuscular Segment of Ileum Combined with Rectal Suspension on Children with Neurogenic Bladder

作　　者：刘宁[1] 张谦[1] LIU Ning;ZHANG Qian(Department of Pediatric Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院小儿外科,河南郑州450052

出　　处：《河南医学研究》2020年第11期1972-1974,共3页Henan Medical Research

摘　　要：目的观察回肠浆肌层膀胱扩大术联合直肠悬吊术治疗小儿神经源性膀胱的效果。方法回顾性分析2014年3月至2018年3月于郑州大学第一附属医院接受回肠浆肌层膀胱扩大术联合直肠悬吊术治疗的53例NB患儿的临床资料。术后随访1~5 a,中位时间2.6 a。观察患儿肾积水与输尿管反流、尿失禁、尿流动力学(UDS)检查及并发症发生情况。结果手术前后患儿美国医疗保健政策与研究机构(AHCPR)尿失禁等级差异有统计学意义(P<0.05)。患儿手术前后国际尿失禁咨询委员会尿失禁问卷简表(ICI-Q-SF)评分分别为(21.35±2.62)、(7.57±0.95)分,差异有统计学意义(P<0.05)。手术后未出现新发肾积水病例,肾积水患儿较前减少,膀胱输尿管反流患儿较前减少,患儿术后膀胱容量、膀胱顺应性均大于术前,差异有统计学意义(均P<0.05)。术后出现3例(5.7%)泌尿系结石,6例(11.3%)泌尿系感染,未发现膀胱穿孔和肿瘤。结论回肠浆肌层膀胱扩大术联合直肠悬吊术能有效改善NB患儿膀胱功能,保护上尿路,缓解尿失禁情况。Objective To observe the effects of bladder augmentation using seromuscular segment of ileum combined with rectal suspension on children with neurogenic bladder(NB).Methods The clinical data of 53 children with NB who underwent bladder augmentation using seromuscular segment of ileum combined with rectal suspension at the First Affiliated Hospital of Zhengzhou University from March 2014 to March 2018 were retrospectively analyzed.The follow-up period was 1-5 a,with an average of 2.6 a.Hydronephrosis,ureteral reflux,urinary incontinence,urodynamics(UDS)examination results and complications were observed.Results The difference in the Agency for Health Care Policy and Research(AHCPR)urinary incontinence levels before and after surgery was statistically significant(P<0.05).Before and after the operation,the International Consultation on Incontinence Questionnaire Short Form(ICI-Q-SF)scores were(21.35±2.62)and(7.57±0.95)respectively,and the difference was statistically significant(P<0.05).No new cases of hydronephrosis occurred after the operation.Postoperatively,fewer children had hydronephrosis,fewer children had bladder ureteral reflux,bladder capacity and compliance increased,and the differences were statistically significant(all P<0.05).Urinary calculi occurred in 3 cases(5.7%)and urinary infection in 6 cases(11.3%)after the operation.No bladder perforation or tumor were found.Conclusion The bladder augmentation using seromuscular segment of ileum combined with rectal suspension could effectively improve the bladder function,protect the upper urinary tract,and relieve urinary incontinence in NB children.

关 键 词：神经源性膀胱 直肠悬吊术 膀胱扩大术 回肠浆肌层 尿流动力学 

分 类 号：R726.9[医药卫生—儿科]