机构地区:[1]郑州大学第一附属医院泌尿外科河南省小儿尿动力国际联合实验室,郑州450052 [2]郑州大学附属信阳医院信阳市中心医院泌尿外科,信阳464099
出 处:《中华医学杂志》2022年第38期3001-3006,共6页National Medical Journal of China
基 金:国家自然科学基金(U1904208)。
摘 要:目的分析儿童非神经源性下尿路功能障碍(NNLUTD)的影像尿动力学和临床特征。方法纳入2016年1月至2020年12月郑州大学第一附属医院确诊为NNLUTD的患儿。通过询问病史、体格检查和影像学检查,排除神经系统疾病、直肠功能障碍及解剖学畸形引起的下尿路功能障碍。所有患儿进行影像尿动力学和尿常规检查,并依据影像尿动力结果分为4组:尿动力结果正常者(Normal组)、单纯逼尿肌过度活动者(DO组)、逼尿肌括约肌协同失调者(DSD组)和逼尿肌活动低下者(DU组)。分析4组患儿临床症状、影像尿动力学结果、尿路感染(UTI)和膀胱输尿管反流(VUR)比例等。结果共173例患儿纳入本研究,男103例、女70例,年龄(7.2±3.3)岁。Normal组46例(26.6%),DO组63例(36.4%),DSD组39例(22.5%)和DU组25例(14.5%)。DSD组和DU组VUR比例均高于Normal组和DO组[18例(46.2%)和11例(44.0%)比7例(15.2%)和14例(22.2%),均P<0.05],DO组VUR患儿中男性构成比高于女性[12例(32.4%)比2例(7.7%),P=0.020];DSD组和DU组UTI比例均高于DO组[16例(41.0%)和12例(48.0%)比12例(19.0%),均P<0.05],Normal组、DO组和DU组UTI患儿中女性构成比均高于男性[9例(45.0%)比4例(15.4%)、8例(30.8%)比4例(10.8%)和7例(87.5%)比5例(29.4%),均P<0.05]。DSD组最大逼尿肌压力高于Normal组、DO组和DU组[(95±47)比(43±18)、(56±18)和(12±9)cmH_(2)O,均P<0.05,1 cmH_(2)O=0.098 kPa];与Normal组和DO组两组相比,DSD组和DU组两组残余尿量均较多[(58±38)和(70±62)比(8±8)和(8±7)ml],两组低顺应性膀胱比例均较高[15例(38.5%)和11例(44.0%)比1例(2.2%)和10例(15.9%)],差异均有统计学意义(均P<0.05);DO组、DSD组和DU组最大膀胱容量均低于Normal组[(178±61)、(184±81)和(194±93)比(256±92)ml,均P<0.05]。4组患儿之间尿急比例差异有统计学意义[Normal组、DO组、DSD组和DU组分别为13例(28.3%)、41例(65.1%)、22例(56.4%)和11例(44.0%),P=0.001];4组患儿之间排尿困难比例差异也有�Objective To analyze the video-urodynamic(VUDS)and clinical features of non-neuropathic lower urinary tract dysfunction(NNLUTD)in children.Methods Children diagnosed with NNLUTD in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2020 were included.Children with neurological,rectal dysfunction and anatomical abnormalities were excluded.VUDS and urinalysis were performed in all children who were divided into 4 groups accordingly:normal group(Normal group),detrusor overactivity group(DO group),detrusor sphincter dyssynergia group(DSD group)and detrusor underactivity group(DU group).VUDS and clinical features,vesicoureteral reflux(VUR)and urinary tract infections(UTI)were analyzed.Results A total of 173 children were included in this study,including 103 males and 70 females,aged(7.2±3.3)years.VUDS showed that 46 cases(26.6%)were in Normal group,63 cases(36.4%)in DO group,39 cases(22.5%)in DSD group and 25 cases(14.5%)in DU group.Compared with Normal group and DO group,the proportion of VUR in DSD group and DU group was significantly higher[18(46.2%)and 11(44.0%)vs 7(15.0%)and 14(22.2%),all P<0.05],and the proportion of male children was significantly higher than that of female children with VUR only in DO group[12(32.4%)vs 2(7.7%),P=0.020];Compared with DO group,the proportion of UTI in DSD group and DU group was significantly higher[16(41.0%)and 12(48.0%)vs 12(19.0%),all P<0.05],and the proportion of female children was significantly higher than that of male children with UTI in normal group,DO group and DU group[9(45.0%)vs 4(15.4%),8(30.8%)vs 4(10.8%)and 7(87.5%)vs 5(29.4%),all P<0.05].The maximum detrusor pressure in DSD group was significantly higher than that in Normal group,DO group and DU group[(95±47)vs(43±18),(56±18)and(12±9)cmH_(2)O,all P<0.05,1 cmH_(2)O=0.098 kPa).Compared with Normal group and DO group,post void residual in DSD group and DU group was significantly increased[(58±38)and(70±62)vs(8±8)and(8±7)ml,all P<0.05],and the proportion of lower bladder compl
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