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目的探讨B超影像尿动力学检查在下尿路功能障碍患儿诊断中的应用价值。方法69例小儿分2组,患儿组54例,为下尿路功能障碍的患儿,男30例,女24例,年龄4～18岁,平均(10.7±3.6)岁;对照组15例,为下尿路正常的患儿(因上尿路异常作下尿路检查者),男11例,女4例,年龄3～17岁,平均(9.9±3.7)岁。分别进行尿动力学检查,同步耻骨上、会阴部和直肠B超观察膀胱壁厚度、膀胱颈口形态、膀胱充盈和排尿后尿道形态等。结果患儿组尿动力学异常表现有残余尿量增多、膀胱顺应性降低、逼尿肌过度活动、逼尿肌括约肌协同失调和逼尿肌瘫痪等,B超影像检查异常表现有膀胱壁增厚、毛糙,颈口抬高,后尿道扩张,排尿期尿道开放不完全等,其中2例后尿道瓣膜患儿发现膀胱憩室。对照组B超影像检查显示充盈期膀胱壁光滑,厚度(2±1)mm,均小于3 mm;膀胱颈口关闭,无抬高;排尿期膀胱颈口、后尿道充分开放,残余尿量小于10ml。结论B超影像尿动力学检查可将膀胱的功能性改变和形态学信息相结合,能更全面准确地诊断和了解下尿路功能障碍。
Objective To investigate the diagnostic value of B-mode urography in the diagnosis of children with lower urinary tract dysfunction. Methods 69 cases of children were divided into 2 groups, 54 cases of children with lower urinary tract dysfunction, 30 males and 24 females, aged 4 to 18 years (mean, 10.7 ± 3.6) years; control group, 15 cases , A normal lower urinary tract (lower urinary tract due to upper urinary tract abnormalities), 11 males and 4 females, aged 3 to 17 years (mean, 9.9 ± 3.7) years. Urodynamic tests were performed respectively, supra-suprapubic, perineal and rectum B-ultrasound were used to observe the thickness of the bladder wall, the shape of the bladder neck, the filling of the bladder and the shape of the urethra after urination. Results The abnormal urodynamics in children showed increased residual urine volume, decreased bladder compliance, detrusor overactivity, detrusor sphincter debility and detrusor paralysis, etc. The ultrasonographic findings of abnormal ultrasound showed bladder wall thickening , Rough, neck lift, posterior urethral dilatation, urethral opening incomplete urination, etc., of which 2 cases of posterior urethral valve found in children with bladder diverticulum. In the control group, B-mode ultrasonography showed that the wall of the bladder during filling was smooth and the thickness was (2 ± 1) mm, both less than 3 mm; the bladder neck was closed without elevation; the bladder neck and urethra were fully open during urination, 10ml. Conclusion B-mode urodynamic examination can combine the functional changes of the bladder with the morphological information to diagnose and understand the lower urinary tract dysfunction more completely and accurately.