摘要
目的探讨回肠浆肌层膀胱扩大术治疗神经源性膀胱患儿的远期疗效。方法应用回肠浆肌层膀胱扩大术治疗神经源性膀胱患儿32例。男23例,女9例;8例术前合并双肾输尿管积水及双侧输尿管扩张,3例单侧膀胱输尿管返流,2例有轻度肾功能损害。对比手术前后主观症状[国际尿失禁咨询委员会问卷简表(ICI-Q-SF问卷)]、尿流动力学检查、泌尿系超声及逆行膀胱造影,评价术后疗效。术后所有患儿定期复查血电解质、肾功能及泌尿系超声,监测并发症。结果随访5～12a,26例(81.25%)临床症状好转或痊愈,6例(18.75%)无明显改善。术前ICI-Q-SF问卷评分为(18.1±1.0)分,随访结束为(7.8±2.5)分,二者比较差异有统计学意义(t=14.688,P=0.000)。尿流动力学检查显示术后最大膀胱容量、膀胱顺应性较术前明显增加,充盈末逼尿肌压较术前降低。术后电解质、肾功能均正常。远期并发症5例:4例并症状性泌尿系感染,1例并膀胱结石。结论回肠浆肌层膀胱扩大术治疗神经源性膀胱患儿并发症少,远期疗效比较理想。
Objective To evaluate the long-time therapeutic effect of a demucosalized ileoseromuscular layer patch containing neurovascular pedicle for the children with neurogenic bladders.Methods A total of 32 children with neurogenical bladder underwent bladder augmentation by using a demucosalized ileoseromuscular layer patch containing neurovascular pedicle（23 males and 9 females）.Eight cases had ureterohydronephrosis and 3 cases had vesicoureteral reflux,2 cases had mild renal impairment.The therapeutic effects were evaluated by means of international continence inquiring committhee questionnaire（ICI-Q-SF）questionnaire,urodynamic examination,ultrasonic examination and cystoradiography.All cases were followed at regular intervals with serum electrolytes,renal function and ultrasonic examination.The complications were monitored.Results The period of follow-up ranged from 5 to 12 years.Twenty-six patients（81.25%）had improvements in their conditions,and the other 6 patients（18.75%）had no improvements after surgery.Before and after operation,the ICI-Q-SF scores were（18.1±1.0）scores and（7.8±2.5）scores,respectively.After the operation,the maximum bladder capacity and compliances were increased,but the bladder pressure at filling end phase was decreased.Serum electrolytes and renal function were normal after operation.Postoperative complications occurred in 5 cases,4 cases of urinary tract infection,1 case of bladder calculi.Conclusions Bladder augmentation by using a demucosalized ileoseromuscular layer patch containing neurovascular pedicle has low complication rate,and shows a better long-term treatment outcome.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2011年第2期146-147,共2页
Journal of Applied Clinical Pediatrics
关键词
膀胱
神经源性
膀胱扩大术
并发症
bladder
neurogenic
bladder augmentation
complication
