神经源性膀胱伴输尿管反流的尿动力学研究

目的 探讨有输尿管反流的神经源性膀胱(NB)患儿有或没有逼尿肌过度活动(DO)时的尿动力学差异,为临床治疗此类患儿提供理论参考依据.方法 选取2013～2015年就诊并经影像尿动力学检查发现膀胱输尿管反流的NB患儿68例,男30例,女38例,年龄4～12岁,平均7.5岁.按照充盈期有DO,将其分为DO组(n=20)与无DO组(n=48).观察记录两组发生膀胱输尿管反流时的膀胱灌注量、逼尿肌压并计算发生反流时的膀胱顺应性;记录两组充盈结束时最大膀胱测压容量、最大逼尿肌压、并计算充盈期膀胱顺应性.结果 DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(98.7±16.1)ml和(5.2±1.9) ml/cmH2O,无DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(127.3±36.3)ml,(7.1±2.1)ml/cmH2O,差异均有统计学意义(P＜0.05);两组的逼尿肌压分别为(21.6±9.2)cmH2O、(19.2±7.4)cmH2O,差异没有统计学意义;DO组充盈结束时的膀胱容量与顺应性分别为(182.7±31.2)ml、(5.4±1.7) ml/cmH2O,与无DO组充盈结束时的膀胱容量(230.6±34.6)ml与顺应性(6.5±1.1)ml/cmH2O相比,差异有统计学意义;两组尿动力学检查结束时逼尿肌压分别为(33.8±7.8)cmH2O、(36.4±8.1)cmH2O,差异没有统计学意义.结论 膀胱容量小,膀胱顺应性差是有输尿管反流的NB患儿伴发DO时的尿动力学特征.

Dynamics of neurogenic bladder with vesicoureteral reflux

Objective To explore the dynamic differences of neurogenic bladder (NB) with ureteral reflux with or without detrusor overactivity so as to provide therapetic rationales.Methods A total of 68 children were diagnosed as NB vesicoureteral reflux by videourodynamics from 2003 to 2005.There were 30 boys and 38 girls with a mean age of 7.5 (4-12) years.Based upon the presence or absence of detrusor overactivity (DO),they were divided into DO group (n =20) and non-DO group (n =48).During vesicoureteral reflux,bladder capacity and detrusor pressure were recorded and bladder compliance was calculated.And the maximal levels of cystometry capacity and detrusor pressure were recorded and bladder compliance was calculated at the end of filling in two groups.According to the level of reflux flow,they were divided into mild reflux (Ⅰ-Ⅱ degrees),severe reflux (Ⅲ-Ⅴ degrees).Reflux side and severity were compared for two groups.Results During vesicoureteral reflux,bladder capacity and compliance were 98.7 ± 16.1 ml and 5.2 ± 1.9 ml/cmH2O in DO group versus 127.3 ± 36.3 ml and 7.1 ± 2.1 ml/cmH2O in non-DO group.The differences had statistical significance.The detrusor pressures of two groups were 21.6 ± 9.2 and 19.2 ± 7.4 cmH2O respectively.There was no significant statistical difference.At the end of filling,bladder capacity and compliance were 182.7 ± 31.2 ml and 5.4 ± 1.7 ml/cmH2O in DO group versus 230.6 ± 34.6 ml and 6.5 ± 1.1 ml/cmH2O in non-DO group.The differences had statistical significance.In DO group,reflux was unilateral (n =12,60％) and bilateral (n=8,40％);in non-DO group,unilateral (n=16,33％) and bilateral (n =32,67％).All refluxes of two groups were severe.Conclusions Small bladder capacity and poor bladder compliance are two major dynamic characteristic of NB children with ureteral reflux during DO.