脊髓拴系综合征并发上尿路扩张患者的尿动力学特征

目的：探讨脊髓拴系综合征(TCS)并发上尿路扩张患者尿动力学特征。方法：对23例TCS并发上尿路扩张患者(扩张组)和26例TCS未并发上尿路扩张患者(对照组)进行尿动力学测定。结果：扩张组患者逼尿肌无收缩伴膀胱低顺应性。其剩余尿量、排尿前逼尿肌压力、最大膀胱压测定容量、逼尿肌漏尿点压、逼尿肌无收缩和逼尿肌漏尿点压大于3．92kPa发生率均显著高于对照组；而膀胱顺应性和神经源性逼尿肌功能过度活跃发生率显著低于对照组。扩张组相对安全容量与对照组之间的差异无统计学意义，而相对危险容量显著大于对照组。结论：TCS并发上尿路扩张患者膀胱多为无反射性膀胱。对本病患者应尽早并定期进行尿动力学检查，及时消除相对危险容量，防止上尿路损害的发生。

The urodynamic study on upper urinary tract dilatation due to tethered cord syndrome

Objective:To study the urodynamic change of upper urinary tract dilation(UUTD) due to tethered cord syndrome(TCS).Methods:Twenty-three TCS patients with UUTD and twenty-six TCS patients without UUTD were included and urodynamic examination was performed in all of them according to the recommendations of the International Children Continence Society (ICCS).Results:The bladders of the UUTD group mainly were presented with detrusor acontractile(ACD) and poor compliance. The residual urine volume, the detrusor pressure before voiding, maximum cystometric capacity, detrusor leak point pressure (DLPP) and incidences of ACD and DLPP more than 3.92 kPa in the UUTD group were significantly higher than those in the control group. And bladder compliance and neurogenic detrusor over activity were significantly lower than those in the control group. There was no significant difference in relatively safe bladder capacity between the UUTD group and the control group, but the unsafe bladder capacity in the UUTD group was significantly higher than that in the control group. The differences of maximum flow rate, detrusor-sphincter dyssynergia, maximum urethral pressure, maximum closure pressure and static functional length between two groups were not significant.Conclusions:Most bladders of UUTD due to TCS are acontractile bladders, and high intravesical pressure is the main risk factor to cause upper tract deterioration. Close urodynamic follow up for these patients is important to the early diagnosis and timely surgical correction of TCS, and essential to the prevention of progressive urinary tract deterioration.