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目的探讨乙状结肠膀胱扩大术治疗神经原性低顺应性膀胱的疗效。方法采用乙状结肠膀胱扩大术治疗l0例神经原性低顺应性膀胱患者。男6例,女4例。年龄4～32岁,平均16岁。病程4～20年。其中脊髓栓系综合征8例,脊髓损伤2例。术前均未接受过骶神经根切断和膀胱手术。有膀胱输尿管返流者同时作返流侧输尿管膀胱再植术。术后不能自行排尿或剩余尿量>50m1者辅以间歇性清洁导尿。结果术后随访11～57个月。术前漏尿者10例,术后仅3例仍有漏尿,但程度明显减轻。血肌酐(SCr)由(263.8±109.8)μmo/L降至(113.1±23.2)μmol/L(P<0.01),膀胱容量由(61.9土37.7)m1增至(373.0土88.1)m1(P<0.01),储尿期最大逼尿肌压力由(54.2±44.8)cm H2O(1cm H20=0.098 kPa)降至(17.7±10.6)cm H20(P<0.01)。有膀胱输尿管返流者由9例17侧减少至l例l侧。需长期间歇性清洁导尿者4例,其中1例因未按时进行间歇性清洁导尿者导致代谢性酸中毒,按时间歇性清洁导尿后治愈。菌尿10例,其中l例需抗生素治疗。结论乙状结肠膀胱扩大术是治疗神经原性低顺应性膀胱的有效方法,能改善患者肾功能,提高患者生活质量。
Objective To investigate the curative effect of sigmoid colon augmentation on neurogenic low compliance bladder. Methods The sigmoid colon augmentation was used to treat l0 cases of patients with low neurogenic bladder. 6 males and 4 females. Age 4 to 32 years old, average 16 years old. Course of 4 to 20 years. Including spinal cord syndrome in 8 cases, 2 cases of spinal cord injury. Preoperative sacral nerve root transection and bladder surgery have not been accepted. A vesicoureteral reflux at the same time as the reflux side of the ureter bladder replantation. After surgery can not urinate or residual urine> 50m1 supplemented by intermittent clean catheterization. Results The patients were followed up for 11-57 months. Preoperative leak of urine in 10 cases, only 3 cases still had urine leakage, but the degree was significantly reduced. Serum creatinine (SCr) was decreased from (263.8 ± 109.8) μmo / L to (113.1 ± 23.2) μmol / L, and bladder volume increased from (61.9 ± 37.7) m1 to (373 ± 88 ± 1) 0.01). The maximum detrusor pressure during storage period decreased from (54.2 ± 44.8) cm H2O (1 cm H20 = 0.098 kPa) to (17.7 ± 10.6) cm H20 (P <0.01). Patients with vesicoureteral reflux were reduced from 9 cases in 17 side to 1 case in side l. Need long-term intermittent cleaning and catheterization in 4 cases, of which 1 case of intermittent cleaning and catheterization due to intermittent lead to metabolic acidosis, intermittent cleansing and catheterization after the cure. Bacteriuria in 10 cases, of which 1 case of antibiotic treatment. Conclusions Sigmoid colon augmentation is an effective method to treat low neurogenic bladder. It can improve renal function and improve quality of life of patients.