清洁间歇导尿在小儿神经源性膀胱治疗中的价值

目的 评价清洁间歇导尿在小儿神经源性膀胱治疗巾的临床意义.方法 脊髓栓系综合征患儿64例.男49例,女15例,年龄3～13岁.均已行脊髓栓系松解手术.临床表现为尿失禁,611例合并大便失禁.52例合并足畸形.就诊时和就诊后1年分别行尿动力学和排泄件膀胱尿道造影以及超声检查,治疗期间36例坚持间歇导尿.28例未能坚持间歇导尿.结果 导尿组开始有9例合并Ⅲ°以下输尿管反流.4例为单纯肾积水.膀胱容量、顺应性、逼尿肌压分别为(176±34.5)ml、(3.5±0.6)ml/cmH2O、(54.6±13.2)cmH2O.1年后3例输尿管反流消失,2例肾积水减轻,膀胱容量、顺应性、逼尿肌压分别为(188±30.3)ml、(3.7±0.9)ml/cmH2O、(50.6±11.8)cmH2O,4例发生尿路感染(11.1%).未导尿组开始有7例合并Ⅲ°以下输尿管反流,5例为单纯肾积水,膀胱容量、顺应性、逼尿肌压分别为(168±37.2)ml,(3.2±0.7)ml/cmH2O,(59.6±15.6)cmH2O.1年后13例合并输尿管反流.9例合并肾积水.膀胱容量、顺应性、逼尿肌压分别为(142±23.6)ml,(1.6±0.7)ml/cmH2O,(72.4±9.3)cmH2O.3例发生尿路感染(10.7%).结论清洁间歇导尿可保护膀胱功能.避免或减轻上尿路功能的损害,并不增加尿路感染的发生率.对于神经源性膀胱治疗有重要的应用价值.

The role of clean intermittent catheterization(CIC) in the treatment of neurogenic bladder

Objective To evaluate the role of clean intermittent catheterization (CIC) in the management of neurogenic bladder in children, Methods Sixty-four children with tethered cord syndrome, who had been undergone spinal cord lysis, were recruited in this study. Among them, 49 were males and 15 were females, aged from 3 to 13 years old.The patients presented with a common symptom of urinary incontinence. Besides this, 60 patients presented with fecal incontinence, and 52 with orthopedic foot deformities. The patients were underwent urodynamic, voiding cystourathrography and ultrasonography immediately and 1 year after diagnosis, respectively. Sixty-four patients were divided into 2 groups: CIC group included 36 children who have performed CIC 5-6 times daily for 1 year, and NO-CIC group included the other 28 children who haven't kept on CIC. Results In CIC group, there were 9 children who had grade 1 through 3 VUR(vesicoureteral reflux) and 4 children who had hydronephrosis. Bladder volume, compliance and detrusor pressure were (176±34. 5) ml, (3. 5 ±0. 6) ml/cmH2O, (54. 6±13. 2) cmH, 2O respectively. One year later after CIC treatment, VUR disappeared in 3 children and hydronephrosis alleviated in 2 children. Bladder volume, compliance and detrusor pressure were (188±30. 3) ml, (3. 7± 0. 9)ml/cmH2O, (50. 6±11.8) cmH2O, respectively. Four children had urinary tract infection (11.1.%). In NO-CIC group, there were 7 children who had grade 1 through 3 VUR and 5 children who had hydronephrosis. Bladder volume, compliance and detrusor pressure were (168±37. 2) ml, (3. 2 ±0.7) ml/cmH2O, (59. 6± 15.6) cmH2O respectively. (One year later, VUR occurred in 13 children and hydronephrosis in 9 children. Bladder volume, compliance and detrusor pressure were (142±23. 6) ml, (1.6±0.7)ml/cmH2O, (72. 4± 9. 3) cmH2O, respectively. Three children had urinary infection(10. 7%). Conclusions CIC can protect bladder and upper urinary tract function without increasing morbidity of urinary tract infection. It plays an important role in the treatment of neurogenic bladder.