回肠近系膜缘纵行切开去管化成形补片法行膀胱扩大术的疗效分析  

Analysis of therapeutic effect of ileocystoplasty with detubularized ileal patch with perimesenteric longitudinal ileal incision

作　　者：王春田 张振华 马楠[1] 孙小刚[1] 罗娟[1] 陈维秀[1] 王若义[1] 李金良[1] 刘倩[1] Wang Chuntian;Zhang Zhenhua;Ma Nan;Sun Xiaogang;Luo Juan;Chen Weixiu;Wang Ruoyi;Li Jinliang;Liu Qian(Department of Pediatric Surgery,Second Hospital,Shandong University,Jinan 250033,China)

机构地区：[1]山东大学第二医院小儿外科,济南250033

出　　处：《中华小儿外科杂志》2024年第8期719-724,共6页Chinese Journal of Pediatric Surgery

基　　金：济南市市校融合发展战略工程项目(JNSX2023009);山东大学第二医院青年基金(26010275618041)。

摘　　要：目的探讨回肠近系膜缘纵行切开去管化成形补片法行膀胱扩大术治疗神经源性膀胱的疗效。方法收集2011年6月至2022年12月山东大学第二医院收治的因脊髓栓系综合征神经源性膀胱接受回肠全层膀胱扩大术的51例患儿的临床资料,接受手术时年龄为(10.66±2.50)岁,年龄范围在3~18岁。按照回肠去管化纵行切开位置分为两组:回肠近系膜缘纵行切开去管化成形补片行膀胱扩大术组(A组)共19例,回肠对系膜侧纵行切开去管化成形补片行膀胱扩大术组(B组)共32例。术后1年对患儿膀胱容积比、顺应性以及充盈期逼尿肌压力等指标进行评估。结果两组患儿在术前基本情况(年龄、身体质量指数)及术前相关检查(膀胱容积比、充盈期逼尿肌压)、术中情况(手术时间、出血量)等差异无统计学意义(均P>0.05),但术后膀胱容积比、顺应性以及充盈期逼尿肌压力存在一定差异(P<0.05)。A组术后膀胱容积比和顺应性比B组更大[(133.2±7.6)%比(93.7±4.0)%,χ^(2)=4.947,P<0.001;(25.0±3.4)ml/cm H_(2)O比(11.9±1.4)ml/cm H_(2)O,t=3.93,P=0.0006];充盈期逼尿肌压力更低[(16.6±1.5)cm H_(2)O比(27.3±3.1)cm H_(2)O,t=2.792,P=0.01]。结论回肠近系膜缘纵行切开去管化成形补片法行膀胱扩大术可有效增加膀胱容量和顺应性,降低膀胱压力,减少手术中所需回肠段长度,是一种安全、有效的方法。Objective To explore the therapeutic effect of bladder augmentation using detubularized ileal patch with perimesenteric longitudinal ileal incision for children with neurogenic bladder(NGB).Methods From June 2011 to December 2022,the relevant clinical data were retrospectively reviewed for 51 NGB children caused by tethered cord syndrome undergoing full thickness ileal bladder augmentation.The median age was(10.66±2.50)(3-18)years.They were assigned into two groups of A and B.First ileal segment was opened adjacent to mesentery,perimesenterically(group A,n=19)and second ileal segment along antemesenteric border(group B,n=32).Each segment was then folded and perimesenteric edges sutured for patching.Bladder volume ratio,compliance and filling phase detrusor pressure were evaluated at one year postoperatively and the inter-group differences were statistically analyzed.Results No significant inter-group differences existed in age,body mass index,preoperative bladder volume ratio,filling phase detrusor pressure,operative duration or intraoperative volume of blood loss(all P>0.05).However,there were inter-group differences in postoperative bladder volume ratio,compliance and filling phase detrusor pressure(P<0.05).Group A had a better postoperative bladder volume ratio and compliance[(133.2±7.6)%vs(93.7±4.0)%,χ^(2)=4.947,P<0.001;(25.0±3.4)vs(11.9±1.4)ml/cm H_(2)O,t=3.93,P=0.0006]and lower filling phase detrusor pressure[(16.6±1.5)vs(27.3±3.1)cm H_(2)O,t=2.792,P=0.01].Conclusion Augmentation for NGB may be carried out by perimesenteric transection of intestinal segment.It improves compliance,expands capacity of neobladder and shortens resected segment.

关 键 词：膀胱 肠系膜 神经源性膀胱 膀胱扩大术 

分 类 号：R726.9[医药卫生—儿科]