脊髓拴系松解术对脂肪脊髓脊膜膨出患儿下肢及膀胱功能的改善作用  

Improvement of lower limb and bladder function in children with lipomyelomeningocele by tethered cordrelease

作　　者：李萃萃 修波[1] 戴宜武 李运军[1] 李文德 林和璞[1] Li Cuicui;Xiu Bo;Dai Yiwu(Department of Neurosurgery,the Seventh Medical Center of PLA General Hospital,Beijing 100700)

机构地区：[1]中国人民解放军总医院神经外科医学部派驻第七医学中心神经外科,北京100700

出　　处：《卒中与神经疾病》2021年第6期676-679,688,共5页Stroke and Nervous Diseases

基　　金：武器装备军内科研科学研究项目(编号为直管[2018]9号)。

摘　　要：目的探讨脊髓拴系松解术对脂肪脊髓脊膜膨出患儿下肢及膀胱功能的改善作用。方法选取2014年3月-2019年3月在本院接受治疗的脊髓拴系综合征(Tethered cord syndrome, TCS)患儿1508例,其中脂肪脊髓脊膜膨出患儿150例,符合手术指征患儿130例;采用脊髓拴系松解术对患儿进行治疗,按照手术时间分为术前、术后2组;比较2组患儿围手术期各项指标、尿动力学参数水平;免疫吸附实验法检测超敏C反应蛋白(High-sensitivity C-reactive protein, hs-CRP)、白介素-8(Interleukin-8,IL-8)水平;免疫透射比浊法检测促肾上腺皮质激素(Adrenocorticotropic hormone, ACTH)、皮质醇(Cortisol, Cor)、丙二醛(Malondialdehyde, MDA)水平;比较2组患儿膀胱功能、双下肢功能改善情况及治疗效果。结果与术前比较,术后患儿逼尿肌漏尿点压(Detrusor leak point pressure, DLPP)、膀胱顺应性(Bladder compliance, BC)、最大膀胱压测定容量(Maximum cystometric capacity, MCC)升高(P<0.05);术后血清ACTH,Cor, MDA,hs-CRP,IL-8水平略高于术前(P<0.05);患儿术后膀胱功能、双下肢功能较术前明显改善(P<0.05)。脊髓拴系松解术治疗TCS患儿其中显效87例、有效39例、无效4例,总有效率为96.92%。结论使用脊髓拴系松解术对TCS患儿进行治疗,避免了对患儿造成的不必要的影响,患儿膀胱功能、双下肢功能恢复良好,且应激反应、炎症反应较轻,安全性、有效性高。Objective To investigate the effect of tethered cord release on the improvement of lower limb and bladder function in children with lipomyelomeningocele. Methods We selected 1508 children with tethered cord syndrome(TCS) treated in our institution from March 2014 to March 2019, including 150 children with lipomyelomeningocelein which 130 children could have an operation withsurgicalindications. Children were treated with tethered cord release and divided into two groups, pre-operation and post-operation groups, according to the time point before or after surgery. Each index and urodynamic parameters during the perioperative period were compared between the two groups. The levels of high-sensitivity C-reactive protein(hs-CRP) and interleukin-8(IL-8) were detected by immunosorbent assay. The contents of adrenocorticotropic hormone(ACTH), Cortisol(Cor) and malondialdehyde(MDA) were detected by immunoassay. The improvement of bladder function and lower limb function was compared between the two groups. Results Compared with pre-operation, the parameters of detrusor leak point pressure(DLPP), bladder compliance(BC) and maximum cystometric capacity(MCC) were significantly increased in children after operation(P<0.05). The contents of serum ACTH, Cor, MDA, hs-CRP and IL-8 were slightly higher after operation than those before operation(P<0.05). The bladder function and lower limbs function of childrenwere significantly improved after operation compared with those before operation(P<0.05). Among them, 87 cases were markedly effective, 39 cases were effective and 4 cases were ineffective. The total effective rate was 96.92%. Conclusion Tetheredcord release was used to treat children with TCS, which avoided negative effects on children. The children recovered wellon the function of bladder and lower limbs withmild stress and inflammation.It’s atreatment with high safety and effectiveness.

关 键 词：脊髓拴系松解术 脊髓拴系综合征 膀胱功能 双下肢功能 

分 类 号：R651.2[医药卫生—外科学]