反射亢进型神经源性尿失禁的外科治疗及康复训练

目的：探讨反射亢进型神经源性尿失禁的外科治疗及康复训练方法。方法：于1992年1月至2000年10月治疗81例反射亢进型神经源性尿失禁患儿，男54例，女27例，年龄4～14岁，术前检查均证实盆底肌松弛，膀胱容量较小。采用双侧髂腰肌加强盆底肌，回肠去粘膜带血管蒂浆肌层补片的基础上，行膀胱扩大术进行治疗，其中5例行锤状肌膀胱颈悬吊。结果：81例随访6个月～7年，尿失禁症状明显改善63例，术后经过严格的训练有改善的18例。但其中2例效果较差。结论：双侧髂腰肌加强盆底肌，回肠去粘膜带血管蒂浆肌层补片加强膀胱逼尿肌基础上行膀胱扩大术是治疗小儿反射亢进型神经源性尿失禁的较好方法，术后必须进行正规的康复功能训练。

Surgical therapy and rehabilitation training for children with hyper-reflexic neuropathic urinary incontinence

Objective To evaluate surgical therapy and rehabilitation training for children with hy-per-reflexic neuropathic urinary incontinence. Methods From Jan. 1992 to Oct. 2000, 81 children (male54, female 27) aging from 4 to 14 years with hyper-reflexic neuropathic urinary incontinence were operat-ed. Loosed pelvic floor muscle and smaller bladder capacity could be noted in all cases before operation. Allpatients underwent augmentative ileocystoplasty combined with strengthening of pelvic floor by iliopsoas,and 5 patients had an additional bladder neck suspension. Results The follow-up from 6 months to 7 yearsshowed that 63 patients had obvious improvement in urinary control, and 18 cases got some improvementafter training, while 2 patients had less effects. Conclusions The satisfactory results can be gained by com-bined augmentative ileocystoplasty with strengthening of pelvic floor by iliopsoas for children with hyper-re-flexic neuropathic urinary incontinence. The regular rehabilitation training should be adopted after opera-tion.