膀胱自体扩大术在神经性膀胱患儿中的应用评价

目的评价逼尿肌部分切除、膀胱自体扩大术的临床疗效。方法选择脊髓脊膜膨出患儿6例,其中男性3例,女性3例,年龄18个月至9岁。患儿均口服索利那新和行清洁间歇导尿3个月后无好转而行逼尿肌部分切除、膀胱自体扩大术,术后予清洁间歇导尿,手术前及术后1年行泌尿系超声、排泄性膀胱尿道造影,并行尿动力评价,评价指标为膀胱容量、膀胱顺应性和充盈末逼尿肌压。结果术前尿动力学检查显示6例患儿膀胱容量减小、膀胱顺应性下降及逼尿肌压升高,其中5例膀胱容量低于预期容量的50%。排泄性膀胱造影4例合并膀胱输尿管反流,其中左、右侧Ⅳ°反流各1例,双侧Ⅳ°反流2例。6例患儿手术后恢复顺利,无穿孔、感染发生。术后1年尿动力学检查显示6例患儿膀胱容量略有增加,但膀胱容量与预期膀胱容量(年龄×30+30)、膀胱顺应性及逼尿肌压力无明显变化,VCUG显示4例输尿管反流无减轻。结论对于膀胱容量明显变小的神经性膀胱患儿,逼尿肌部分切除、膀胱扩大术不能有效增加膀胱容量和顺应性,降低逼尿肌压,临床不能取得满意的效果。

Clinical evaluations of bladder autoaugmentation in children with neurogenic bladder dysfunction

Objetive To evaluate the outcomes of bladder autoaugmentation in children with neurogenic bladder dysfunction. Methods Six children with myelomeningocele were recruited.There were 3 boys and 3 girls with an age range of 18 months to 9 years.All children underwent bladder autoaugmentation after solifena-cin and clean intermittent catheterization for 3 months.Vesicourethrography (VCUG),ultrasonography and urodynamics were evaluated before and 1 year post-operation.All patients received postoperative clean intermit-tent catheterization.Bladder volume,compliance and detrusor pressure during filling were recorded. Results Preoperative urodynamics indicated that bladder volume and compliance decreased while detrusor pressure in-creased.Bladder volumes of 5 children were lower than 50% of their expected volumes.VCUG indicated thatⅣ°vesicourethral reflux (VUR)existed in 4 children (left,n =1 ∶right,n =1;bilateral,n =2).There was no onset of infection or perforation.At 1 year,bladder volume increased slightly while the rate of bladder vol-ume to expected volume,compliancce and detrusor pressure had no difference.And VUR showed no relief in 4 children. Conclusions Bladder autoaugmentation fails to increase bladder volume and compliance and de-crease detrusor for children with neurogenic bladder of markedly decreased volume.The clinical outcomes are poor.