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目的探讨神经原性膀胱手术方式选择与术后并发症。方法神经原性膀胱患儿94例,年龄3～19岁,平均9岁。表现为不同程度大小便失禁。选用术式包括①盆底肌加强,②膀胱颈悬吊,③膀胱扩大,④Malone术和⑤输尿管抗返流术。本组行手术组合为:①+②+③49例,①+②+③+④16例,①+②+③+⑤16例,①+②+⑤4例,②+⑤1例,①+②5例,③+⑤3例。术后半年评价疗效采用ICIQSF评分和尿动力学检查、IVU,并分析并发症。结果手术前后尿失禁症状评分(16.1±1.7和8.4±2.1)、实际容量与预计容量之比(0.4±0.2和1.2±0.2)、顺应性[(3.0±1.7)和(11.9±2.4)ml/cmH2O)]、充盈末期膀胱压力[(60.8±30.7)和(46.3±24.8)cmH2O],差异均有统计学意义(P值均<0.05)。术后并发症24例(25.5%),近期12例,远期12例;盆腔感染2例,会阴感染1例,尿性腹膜炎2例,肠梗阻3例,膀胱阴道瘘1例,膀胱输尿管连接处狭窄1例,膀胱腹壁瘘2例,肛瘘2例,膀胱挛缩3例,尿路感染2例,膀胱结石3例,输尿管返流2例。结论盆底肌加强、膀胱颈悬吊和膀胱扩大手术组合是治疗神经原性膀胱基本手术。术前肠道充分准备,术中严格无菌操作,操作仔细,彻底止血,术后引流充分,坚持间歇导尿是减少术后并发症的有效方法。
Objective To investigate the choice of neurogenic bladder surgery and postoperative complications. Methods 94 cases of neurogenic bladder children, aged 3 to 19 years, mean 9 years. Showed varying degrees of incontinence. Selection of surgical procedures include ① pelvic floor muscle strengthening, ② bladder neck suspension, ③ bladder expansion, ④ Malone surgery and ⑤ ureteral anti-reflux surgery. The group of surgical combination of: ① + ② + ③ 49 cases, ① + ② + ③ + ④ 16 cases, ① + ② + ③ + ⑤ 16 cases, ① + ② + ⑤ 4 cases, ② + ⑤ 1 case, ① + ② 5 cases, ③ + ⑤ 3 cases. Six months after the operation, the ICIQSF score and urodynamic test were used to evaluate the efficacy and IVU. The complications were analyzed. Results The scores of urinary incontinence before and after surgery (16.1 ± 1.7 and 8.4 ± 2.1), the ratio of actual volume to expected volume (0.4 ± 0.2 and 1.2 ± 0.2), compliance [(3.0 ± 1.7) and (11.9 ± 2.4) ml / cmH2O)], and there was significant difference in bladder filling pressure at the end of filling [(60.8 ± 30.7) vs (46.3 ± 24.8) cmH2O] (all P <0.05). There were 24 cases (25.5%) of postoperative complications, 12 cases in the recent period and 12 cases in the long term; 2 cases of pelvic infection, 1 case of perineal infection, 2 cases of urinary peritonitis, 3 cases of intestinal obstruction, 1 case of vesicovaginal fistula, Department of stenosis in 1 case, 2 cases of bladder abdominal fistula, 2 cases of anal fistula, bladder contracture in 3 cases, urinary tract infection in 2 cases, 3 cases of bladder stones, ureteral reflux in 2 cases. Conclusion pelvic floor muscle strengthening, bladder neck suspension and bladder expansion surgery combination is the treatment of neurogenic bladder basic surgery. Preoperative bowel preparation, strict intraoperative aseptic technique, careful operation, complete hemostasis, full drainage, adherence intermittent catheterization is an effective way to reduce postoperative complications.