小儿神经原性膀胱手术前后尿流动力学检查评价

目的　基于手术前后尿流动力学检查结果的分析，对小儿神经原性膀胱逼尿肌和括约肌不协调的成因进行讨论,并对外科治疗进行评价。方法　55例行盆底肌加强及膀胱颈悬吊的神经原性膀胱患儿于术前和术后4～10个月行尿流动力学对照检查，然后分析其结果并行统计学处理。结果　34例逼尿肌反射亢进型中,30例术后逼尿肌和括约肌不协调减轻或较协调,4例无变化。最大膀胱容量增加（89.0±17.2）ml,最大尿道压力下降（2.7±0.37）kPa,最大尿道闭合压下降（3.1±0.6）kPa;21例术后逼尿肌无反射或反射低下型,逼尿肌反射明显改善11例,改善10例,最大膀胱容量增加（55.6±10.3）ml,最大尿道压力增加（2.9±0.7）kPa,最大尿道闭合压增加（2.6±0.7）kPa。结论　盆底肌加强和膀胱颈悬吊手术是治疗小儿神经原性膀胱的良好术式。因腰骶部脊膜膨出所致的小儿神经原性膀胱逼尿肌与外括约肌协同失调本质上可能是尿道外括约肌对漏斗状膀胱颈代偿性收缩的一个表现。

Urodynamic study on neurogenic bladder after pelvic floor strengthening and vesical neck suspensing in children

Objective To discuss the formation of detrusor urinae-externalsphincter dyssynergia and evaluate the outcome of surgical treatment by urodynamic study.Methods Fifty-five children with neurogenic bladder (NB) who underwent pelvic floor strengthening and bladder neck suspension were checked up on urodynamic study before and 4-10 months after operation. The functional variance of bladder and urethra , and relationship between detrusor urinae and sphincter were analyzed statistically.Results Of 34 cases with hyperreflexic detrusor of NB , 30 cases were improved and 4 invalid. The maximal bladder volume increased 89±17.2ml , the maximal urethral pressure decreased 3.1±0.6kPa . Among 21 cases with areflexia or reflex inhibition of NB, the reflex of detrusor urinae in 11 was improved obviously , and 10 was better. The maximal bladder volume increased 55.6±10.3ml ,the maximal urethral pressure decreased 2.9±0.7kPa.Conclusions The pelvic floor strengthening and bladder suspension are effective procedures in the treatment for NB in children. It is suggested that the detrusor external- sphincter dyssynergia is a compensatory contraction of the external sphincter to the funnel-like bladder neck from paralysis of pelvic floor in lumbosacral myelomeningocele.