前尿道瓣膜切除术后膀胱功能异常与上尿路损害的关系  

Relationship between bladder dysfunction and upper urinary tract damage after anterior urethral valve resection

作　　者：田军[1] 张潍平[1] 孙宁[1] 黎思宇 李明磊[1] 宋宏程[1] 李宁[1] 屈彦超[1] 梁海燕[1] 韩文文[1] 李振武[1] 杨洋[1] 王冠男[1] 刘超[1] 王文杰[1] 黄澄如[1] Tian Jun;Zhang Weiping;Sun Ning;Li Siyu;Li Minglei;Song Hongcheng;Li Ning;Qu Yanchao;Liang Haiyan;Han Wenwen;Li Zhenwu;Yang Yang;Wang Guannan;Liu Chao;Wang Wenjie;Huang Chengru(Department of Urology,Affiliated Beijing Children's Hospital,National Children's Medical Center&Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿科医学中心,首都医科大学附属北京儿童医院泌尿外科,北京市100045

出　　处：《临床小儿外科杂志》2020年第11期996-1001,共6页Journal of Clinical Pediatric Surgery

基　　金：北京市医院管理局“登峰”人才培养计划(编号:DFL20151102)。

摘　　要：目的探讨前尿道瓣膜切除术后造成上尿路持续损害的尿动力学危险因素。方法回顾性分析2007年1月至2020年1月26例前尿道瓣膜切除术后患儿的临床资料,平均年龄3.4岁(5个月至14岁)。瓣膜切除术后4个月至12.5年,平均5.5年。患儿术后均进行尿动力学检查。手术前后均进行血生化(包括尿素氮、肌酐)检查、泌尿系统B超检查、静脉肾脏造影(intravenous pyelography,IVP)和排尿性膀胱尿道造影(voiding cystourethrogram,VCUG)。比较瓣膜切除前后肾和输尿管积水以及膀胱输尿管反流情况,分析造成前尿道瓣膜术后上尿路持续损害的危险因素。结果前尿道瓣膜切除手术前肾和输尿管积水患儿共15例24侧,占57.7%(15/26);膀胱输尿管反流8例11侧,占30.8%(8/26)。瓣膜切除术后有5例7侧肾和输尿管积水消失,占19.2%(5/26);2例3侧膀胱输尿管反流消失。瓣膜切除术后肾和输尿管积水患儿共10例17侧,占38.5%(10/26);膀胱输尿管反流6例8侧,占23.1%(6/26)。有7例11侧肾和输尿管积水较术前加重,占26.9%(7/26),其中4例6侧膀胱输尿管反流较术前加重。根据术后肾和输尿管积水以及膀胱输尿管反流恢复情况,分为上尿路损害加重组(7例)和上尿路损害减轻或消失组(19例)。行瓣膜切除术后尿动力学检查发现,在上尿路损害加重组7例患儿中,压力流率图显示5例依然存在下尿路梗阻或可疑梗阻。上尿路损害减轻或消失组19例患儿压力流率图均显示无梗阻(P<0.05);两组最大尿流率平均值、膀胱顺应性、排尿期最大逼尿肌压力值差异均存在统计学意义(P<0.05);上尿路损害加重组中5例动态VUCG显示排尿时膀胱颈全程开放不全,行膀胱尿道镜检查发现3例膀胱壁增厚,呈小梁样改变和膀胱假性憩室形成,尤其膀胱基底以及膀胱内口附近组织明显增厚。结论前尿道瓣膜是一种罕见的下尿路梗阻性疾病,瓣膜切除之后上尿路损害仍然会持续存Objective To explore the urodynamic risk factors for continuous damage of upper urinary tract after anterior urethral valve(AUV)resection.Methods A retrospective analysis was performed for 26 children undergoing AUV resection from January 2007 to January 2020.The mean age was 40.8(5-168)months after resection and the mean occurring time 66(4-150)months.Urodynamic examinations were performed.Before and after operation,blood biochemical tests of urea nitrogen and creatinine,ultrasonography of urinary system,intravenous pyelography(IVP)and voiding cystourethrogram(VCUG)were performed.Hydronephrosis and vesicoureteral reflux were compared before and after resection for analyzing the risk factor for continuous damage of upper urinary tract after AUV.Results There were 15 cases(24 sides)with hydroureteronephrosis,(57.7%,15/26)and 8 cases(11 sides)with vesicoureteral reflux(30.8%,8/26)before resection.Hydroureteronephrosis disappeared in 7 sides of 5 cases(19.2%)and vesicoureteral reflux was cured in 2 cases(3 sides).There were 10 cases(17 sides)with hydroureteronephrosis after resection(38.5%,10/26)and 6 cases(8 sides)with vesicoureteral reflux(23.1%,6/26).Hydroureteronephrosis in 7 cases(11 sides)worsened than that before operation,26.9%(7/26),including 4 cases with 6 sides of vesicoureteral reflux.According to postoperative hydroureteronephrosis and vesicoureteral reflux,they were divided into upper urinary tract damage aggravation group(n=7)and upper urinary tract damage reduction/disappearance group(n=19).Urodynamic examination after resection showed that lower urinary tract obstruction or suspected obstruction persisted in 5 cases of upper urinary tract damage aggravation group.However,no obstruction was found in 19 children in upper urinary tract damage reduction/disappearance group(P<0.05).Also significant inter-group differences existed in mean maximal flow rate,bladder compliance and maximal detrusor pressure during micturition(P<0.05).In 5 cases,bladder neck was not completely opened during micturition.And bl

关 键 词：前尿道瓣膜 外科手术 尿动力学 

分 类 号：R726.1[医药卫生—儿科] R726.9[医药卫生—临床医学]