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目的:研究铥激光经尿道膀胱内肌层网状全层切开术治疗高张力性神经源性膀胱的可行性。方法:3例高张力小容量神经源性膀胱患者,男2例,分别为29岁、40岁,分别患先天性脊膜膨出、椎管室管膜瘤;女1例,21岁,患脊髓栓系综合征。3例患者均行常规尿动力学检查及逆行膀胱造影提示小容量高张力性神经源性膀胱。手术均在全麻下进行,患者取截石位,经尿道置入膀胱腔内操作器械,采用1 900nm的Vela激光直射光纤,能量为40 W,低压观察膀胱内壁后,在膀胱三角区以外的膀胱壁呈网状多处全层切开膀胱肌层,直至显露肌层外方浆膜层,或多处切开膀胱壁小梁,注意保护膀胱肌层的血运。术后留置膀胱冲洗1天,术后1周评价治疗效果。结果:1例患者取得满意效果,术后复查尿动力学检查及逆行膀胱造影,膀胱容量明显增加,储尿期膀胱内压降低,能依靠腹压自主排尿,无明显剩余尿。另2例患者排尿症状、膀胱容量及输尿管反流情况无明显改善。结论:铥激光经尿道膀胱内肌层网状全层切开术治疗高张力性神经源性膀胱对部分患者具有一定的疗效,但病例的选择以及疗效的持续时间,还需积累更多的病例观察。
OBJECTIVE: To study the feasibility of laser transurethral resection of the bladder intramembrane holorectomy for hypertonic neurogenic bladder. Methods: Three patients with high-tension and small-capacity neurogenic bladder were enrolled in this study. There were 2 males, aged 29 years and 40 years old, with congenital meningocele and ependymoma respectively. There were 1 female, 21 years old, Tethered cord syndrome. All 3 patients underwent routine urodynamic examination and retrograde cystography to suggest small-capacity high-tension neurogenic bladder. Surgical operations were performed under general anesthesia. The patients underwent lithotomy and transurethral resection of intracranial devices. Vela laser direct fiber (1 900 nm) was used. The energy was 40 W. After low-pressure observation of the bladder wall, Bladder wall was reticulated multiple full-thickness incision of the bladder muscle layer, until the outer layer of muscle serosa revealed layer, or multiple incision of the bladder wall trabeculae, pay attention to protect the blood supply of the bladder muscle layer. Postoperative bladder irrigation 1 day postoperative 1 week evaluation of treatment. Results: One patient achieved satisfactory results. Urine dynamic examination and retrograde cystography were performed after operation. Bladder volume was significantly increased. Urinary bladder pressure during storage was decreased. Urinary bladder relied on abdominal pressure without urination. The other two patients had no significant improvement in urination symptoms, bladder capacity and ureteral reflux. Conclusion: 铥 Laser transurethral resection of bladder intramembrane holle rectum for the treatment of hypertonic neurogenic bladder has some curative effect on some patients, but the choice of patients and the duration of curative effect also need to accumulate more cases Observed.