保留膀胱粘膜的肠浆肌层膀胱扩大术近期疗效

目的 探讨治疗反射亢进型神经源性膀胱的最佳手术方法。方法 对术前临床评价均为“差”的25例逼尿肌反射亢进选型神经源性膀胱患儿行保留膀胱粘膜的小肠浆肌层膀胱扩大术。其中12例合并输尿管返流;21例获得随访,随访时间6个月－2年,对比手术前后血电解质、尿素氮、肌酐的变化,同时行排泄性膀胱尿道造影、尿流动力学观察及临床评价。结果 手术后膀胱容量、膀胱顺应性、尿流率较术前增加,逼尿肌压降低,残余尿／膀胱容量比值较术前降低,无抑制收缩减轻。术后临床评价4例为优,9例为良,改善和差者各4例;7例恢复尿意,9例输尿管返流减轻,均无电解质紊乱及肾功能异常。结论 保留膀胱粘膜的双层肠浆肌层膀胱扩大治疗反射亢进型神经源性膀胱近期疗效比较理想。

Recent outcome of bladder augmentation using deepithelialiezed segment of small intestine lined with urothelium

Objective To evaluate urodynamically and clinically bladder augmentation using double deepithelialized segment of the small intestine lined with urothelium to analyse the recent outcome in the treatment of hyperreflexia neurogenical bladder. Methods 25 patients with neurogenical bladder underwent bladder augmentation using deepithelialized segment of the small intestine lined with urothelium (4 14 years old, 16 males and 9 females) from October 1998 to October 2000. 21 patients were followed up. Voiding cystoureterography and urodynamic and clinical evaluation were performed, and serum electrolyte, urea nitrogen and creatinine were tested before and 6 months to 2 years after operation. Results After operation, bladder volume, maximum urine flow rate and compliance were increased, but residual urine/bladder volume and detrusor pressure decreased. Uninhibitory contraction decreased in 15 patients. In 12 patients associated with vesicoureteral reflux, clinical evaluation revealed poor outcomes before operation, but excellent (4 patients), good (9), effective (4), poor outcomes (4) after operation. Seven patients had urinary sensation recovered. Vesicoureteral reflux decreased in 9 patients. There were no electrolyte unbalance and abnormal renal function in all patients. Conclusions Bladder augmentation using double deepithelialized segment of the small intestine lined with urothelium showed a better result currently.