隐性脊柱裂对儿童原发性夜间遗尿症治疗的影响

目的 探讨隐性脊柱裂(spina bifida occulta,SBO)对儿童原发性夜间遗尿症(primary nocturnal enuresis,PNE)治疗效果的影响.方法 收集2011年7月至2013年12月门诊PNE患儿163例,年龄(9.2±2.1)岁,男98例,女65例,这些患儿每周至少出现1次夜间遗尿,均有觉醒困难,无其他泌尿系疾病或脊柱裂引起的临床症状.记录患儿有无SBO体征(背部多毛、色素沉着、潜毛窦等).常规拍摄腰骶椎X线正位片、尿常规.治疗前均记录排尿日记,治疗开始后每月记录1次排尿日记,统计功能性膀胱容量(functional bladder capacity,FBC).根据有无SBO分为非SBO组和SBO组,给予相同的治疗方案,每周记录遗尿次数,每月随访一次,至少随访半年.通过比较非SBO组和SBO组遗尿次数来比较治疗效果.结果 发现SBO 122例(占74.8％),男69例(56.6％),平均年龄(9.8±2.3)岁,伴有隐性脊柱裂阳性体征者55例(45.1％).非SBO者41例,平均年龄(9.5±2.5)岁,男24例(58.5％),女17例(41.5％).两组年龄差异无统计学意义(P＞0.05).治疗前SBO组FBC为(216.5±49.6)ml,非SBO组为(217.4±47.3)ml,P＞0.05,差异无统计学意义.治疗后FBC增加量SBO组为(11.9±4.4)ml,非SBO组为(24.1±6.6)ml,P＜0.001,差异有统计学意义.治疗前SBO组每周遗尿次数为(3.4±1.2)次,非SBO组为(3.1±1.0)次,P＞0.05,差异无统计学意义.治疗后SBO组完全有效25例(20.5％),有效25例(20.5％),部分有效34例(27.9％),无效38例(31.1％);非SBO组完全有效20例(48.8％),有效10例(24.4％),部分有效9例(22.0％),无效2例(4.8％).SBO组和非SBO组治疗效果差异有统计学意义(P＜0.001),非SBO组完全有效率明显高于SBO组(P＜0.001).结论 SBO显著影响儿童PNE的治疗效果.

Impact of spina bifida occulta on the response to treatment of primary nocturnal enuresis

Objective To explore the impact of spina bifida occulta (SBO) on the response to treatment of primary nocturnal enuresis (PNE).Methods Between July 2011 to December 2013,clinical records were reviewed for 163 PNE children.Bedwetting appeared at least once weekly.And all of them had arousal dysfunction.Children with other organic urological diseases or symptoms suggestive of spinal dysraphism were excluded.Bladder diary was recorded before PNE treatment and it was maintained monthly during treatment.Functional bladder capacity (FBC) was collected from bladder diary.SBO children were examined by radiography.They were divided into two groups of SBO and non-SBO.And the same treatment was offered.The weekly frequency of enuretic episodes was recorded.The follow-up frequency was monthly and lasted at least 6 months.Treatment responses were compared between children with and without SBO.Results Among 163 children,SBO was detected in 122 children (74.8％) (9.8 ± 2.3 years),69 were boys.The signs of SBO were present in 55 children.Among 41 non-SBO children (9.5 ± 2.5 years),there were 24 boys.No intergroup significance existed in age (P＞0.05) and FBC pre-treatment (SBO (216.5 ± 49.5) ml and nonSBO (217.4 ± 47.3) ml,P＞0.05).There was significant intergroup difference in increment of FBC post-treatment [SBO group:(11.9-± 4.4) vs non-SBO group:(24.1 ± 6.6) ml,P＜0.05].No significance existed in the frequency of enuretic episodes pre-treatment [SBO group:(3.4 ± 1.2) vs non-SBO:group:(3.1-± 1.0),P＞0.05).In SBO group,25(20.5％) patients showed complete response,25(20.5％) response,34(27.9％) partial response and 38(31.1％) no response.Among 41 non-SBO patients,20(48.8％) showed complete response,10(24.4％) response,9(22.0％) partial response and 2 (4.8％) no response.Significant inter-group difference existed in outcomes.And complete response was more likely in non-SBO children (P＜0.001).Condusions The presence of SBO significantly affects the treatment responses of PNE patients.