脊髓发育不良患者尿路功能障碍特征及手术疗效评估的研究

目的：探讨引起脊髓发育不良患者上尿路损毁的危险因素,并评估膀胱扩大术对此类患者的疗效。方法依据上尿路损毁的标准将150例患者分为有或无上尿路损毁2组,对年龄、性别、病程、既往脊柱手术史、膀胱管理方式、影像尿动力学参数是否与上尿路损毁有关进行研究。然后,从中筛选出曾行膀胱扩大术的37例患者,通过比较手术前后肾功能（以血肌酐值代表）、肾积水和输尿管扩张、膀胱输尿管反流、膀胱容量、膀胱顺应性、储尿期最大逼尿肌压,来评估膀胱扩大术的疗效。结果脊髓发育不良患者下尿路功能障碍中膀胱顺应性降低（79.3%）最为常见,并且是上尿路损毁的主要危险因素（P =0.001,OR =2.802,95% CI：1.510~5.199）。膀胱扩大术不仅能改善膀胱顺应性（P =0.000）,还能增大膀胱容量（P =0.000）、降低储尿期最大逼尿肌压力（P=0.008）,进而改善肾功能（P =0.000）、肾积水（94.2%）、输尿管扩张（94.0%）和膀胱输尿管反流（94.1%）。结论脊髓发育不良患者下尿路功能障碍中膀胱顺应性降低最为常见,并且是上尿路损毁的最主要危险因素。膀胱扩大术能阻止、甚至改善或逆转上尿路损毁。

Characteristics of urinary tract dysfunction and evaluation of surgical treatment in patients with myelodysplasia

Objective To investigate risk factors for upper urinary tract damage in patients with myelodysplasia and to assess the efficacy of bladder augmentation for such patients. Methods A total of 150 patients were divided into two groups according to the standards of upper urinary tract damage for studying the relationship between upper urinary tract damage and age, gender, course of disease, previous spinal surgery, bladder management, and video urodynamic parameters. Then, 37 cases with bladder augmentation were screened to assess the efficacy of bladder augmentation by comparing renal function（serum creatinine value）, hydronephrosis, ureteral dilatation, vesicoureteral reflux, bladder capacity, bladder compliance, maximum detrusor pressure before and after surgery. Results The poor bladder compliance（79. 3% ） was the most common finding in myelodysplasia patients with lower urinary tract dysfunction, and was a major risk factor for upper urinary tract damage（P=0. 001, OR=2. 802, 95% CI： 1. 510-5. 199）. Bladder augmentation could not only improve bladder compliance（P=0. 000）, but also increase bladder capacity（P=0. 000）, reduce maximum detrusor pressure during urine storage period（P=0. 008）, thus improving renal function（P=0. 000）, hydronephrosis（94. 2% ）, ureteral dilatation（94. 0% ） and vesicoureteral reflux（94. 1% ）. Conclusion The poor bladder compliance was the most common finding in myelodysplasia patients with lower urinary tract dysfunction, and was a major risk factor for upper urinary tract damage. Bladder augmentation could stop and improve or even reverse the upper urinary tract damage.