新生儿Currarino综合征并发尿潴留四例并文献复习  

Neonatal Currarino syndrome with urinary retention:a report of 4 cases and a literature review

作　　者：桂琳玲 鲁巍 方琼 邢福中[1] 熊晓峰[1] 肖必栋 余雷[1] Gui Linling;Lu Wei;Fang Qiong;Xin Fuzhong;Xiong Xiaofeng;Xiao Bidong;Yu Lei(Department of Neonatal Surgery,Municipal Children's Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院新生儿外科,430016

出　　处：《中华小儿外科杂志》2020年第7期650-656,共7页Chinese Journal of Pediatric Surgery

基　　金：武汉市卫生和计划生育委员会科研项目(WX17C15)。

摘　　要：目的:探讨对新生儿Currarino综合征引起尿潴留患儿的治疗、预后并文献复习。方法:回顾性分析2007年1月至2019年1月武汉儿童医院新生儿外科收治的新生儿Currarino综合征并发尿潴留4例及1998年1月至2019年1月文献报道的Currarino综合征出现排尿异常16例进行文献复习。结果:2例为直肠肛管狭窄+骶前畸胎瘤+脊髓脊膜膨出+骶骨异常,行后矢状路根治手术后出现急性尿潴留,其中1例术后2个月恢复排尿,1例并发神经源性膀胱。另2例为高位肛门闭锁+骶前畸胎瘤+尾椎缺如,其中1例因骶前肿物压迫尿道突然无尿,行后矢状路骶前肿块切除及肛门成形术,术后排尿功能恢复,1例为出生后即出现尿潴留、双肾积水,二期行Pe?a术中时发现骶前包块,术后复查膀胱潴留及肾积水加重。通过文献检索,总共有20例纳入本次研究,患儿平均年龄为1个月,尿潴留13例,尿失禁4例,神经源性膀胱3例,12例有脊髓脊膜膨出,4例脊髓栓系,7例圆锥水平低位。结论:新生儿Currarino综合征常并发排尿异常、骶前包块压迫尿道,手术中对盆神经及骶髓的损伤、骶前脊髓脊膜膨出以及脊髓圆锥水平较低是影响手术效果的主要原因。Objective To explore the outcomes of neonatal Currarino syndrome with urinary retention and a literature review.Methods From 2007 to 2019,a retrospective review was conducted for 4 neonates with Currarino syndrome with concurrent urinary retention.And 16 cases of Currarino syndrome with abnormal urination were retrieved from the databases from 1998 to 2019.Results Two neonates were operated for anorectal stenosis,presacral teratoma,anterior sacral meningocele and sacral deficiency.Acute urinary retention occurred after radical operation via a posterior sagittal approach in a prone position.One case resumed voiding within 2 months and another complicated with neurogenic bladder.Another 2 patients were characterized as high anal atresia,presacral teratoma and tailbone deficiency.One case had sudden anuria due to oppressed urethra by anterior sacral mass and recovered by mass resection and anoplasty.One case had a postnatal onset of urinary retention and double hydronephrosis.A second-stage Pena operation revealed anterior sacral teratoma and urinary dysfunction deteriorated.Through a literature search,20 children were included.The median age was one month,urinary retention was achieved(n=13)and urinary incontinence(n=4)and neurogenic bladder(n=3).Preoperative spinal anomalies included anterior meningocele(n=12),tethered cord(n=4)and low-lying conus(n=7).Conclusions Neonatal Currarino syndrome is often associated with abnormal micturition and presacral mass oppressing urethra.Intraoperative damage of pelvic and lumbosacral nerves,anterior meningocele and low-lying conus are the major influencing factors of postoperative complications and surgical outcomes.

关 键 词：尿潴留 CURRARINO综合征 神经源性膀胱 新生儿 

分 类 号：R726.9[医药卫生—儿科]