单纯肠道膀胱扩大术治疗低顺应性膀胱合并返流患者的疗效随访  

Efficacy of bladder augmentation for patients with low compliance bladder and vesicoureteral reflux

作　　者：易炜[1] 张汉超[1] 杨跃[1] 汪自力[1] 胡海峰[1] YI Wei;ZHANG Hanchao;YANG Yue;WANG Zili;HU Haifeng(Department of Urology,Affiliated Hospital and Clinical Medical College of Chengdu University,Chengdu 610081,China)

机构地区：[1]成都大学附属医院泌尿外科,四川成都610081

出　　处：《现代泌尿外科杂志》2022年第6期494-498,共5页Journal of Modern Urology

摘　　要：目的探讨低顺应性膀胱合并返流患者接受单纯乙状结肠膀胱扩大术后临床和尿动力学结果。方法回顾性分析2014年6月-2020年1月间在成都大学附属医院确诊为低顺应性高压膀胱合并返流患者15例患者术后平均3.7年(1~6年)的随访资料。所有患者均在接受了单纯乙状结肠膀胱扩大术治疗且同期未予抗返流手术纠正输尿管返流。随访资料包括泌尿系超声、尿常规、肾功能、膀胱管理方式、后续干预措施、肠道功能及由影像尿动力学检查评估的患者术后膀胱功能及返流情况变化。结果各患者在接受肠道膀胱扩大术后膀胱容量和顺应性明显改善,膀胱内压力显著下降,术后输尿管返流情况均好转,11例重度返流(Ⅳ~Ⅴ级)患者中的7例返流消退,4例改善,另外的4例轻度返流(Ⅰ~Ⅲ级)患者返流均完全消退。全部患者的肾功能恢复正常。术后2例患者偶有漏尿,药物治疗后可维持控尿。15例患者中8例患者采用清洁间歇导尿排尿;3例青年男性患者采用腹压排尿;4例患者自行排尿。3例患者出现尿路感染。1例患者新发膀胱结石。结论单纯乙状结肠膀胱扩大术对于高压、低顺应性膀胱合并输尿管返流患者疗效确切,可提供持久的临床和尿动力学改善。Objective To assess the clinical and urodynamic outcomes of bladder augmentation in patients with low compliance bladder and vesicoureteral reflux.Methods The clinical data of 15 patients with low compliance high-pressure bladder and vesicoureteral reflux who received bladder augmentation in our institution during Jun.2014 and Jan.2020 were retrospectively analyzed.No effort had been made to correct existing reflux in the patients.Clinical outcomes including sonography of the upper and lower urinary tract,urinalysis,renal function,bladder management,subsequent interventions and bowel function were addressed.The status of vesicoureteral reflux and bladder function were assessed with video-urodynamics.Results During the mean follow-up of 3.7(1—6)years,video-urodynamics manifested a significant improvement of bladder capacity and compliance,and diminution of intravesical pressure.Of the 11 patients with high grade reflux(Ⅳ-Ⅴ),reflux resolved in 7,downgraded in 4,and of the 4 cases with low grade reflux(Ⅰ-Ⅲ),reflux completely disappeared after surgery.Occasional leakage was observed in 2 cases,and urine control could be maintained after drug treatment.Clean intermittent catheterization was indwelt in 8 cases,3 young men urinated with abdominal pressure,and 4 patients regained voiding.Febrile urinary tract infection was observed in 3 cases,and de novo bladder stone was observed in 1 case.Conclusion Bladder augmentation can be a good choice for patients with low compliance bladder and vesicoureteral reflux,which can provide durable clinical and urodynamic improvement.

关 键 词：膀胱扩大术 低顺应性膀胱 输尿管返流 尿动力学 

分 类 号：R694[医药卫生—泌尿科学]