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背景:脊柱裂引起的脊髓发育不良是儿童最常见的神经系统发育畸形之一,由此而引起的神经原性尿失禁可严重影响患儿的生活质量。目的:观察反射亢进型神经源性尿失禁的手术治疗及术后排尿训练效果。设计:前后对照,随访观察。单位:郑州大学第一附属医院的小儿外科。对象:于1992-01/2000-10治疗81例反射亢进型神经原性尿失禁患儿,男54例,女27例,年龄4～14岁,术前检查均证实盆底肌松弛,膀胱容量小。所有患者均为神经原性尿失禁患者并经尿流动力学结果证实为反射亢进型神经原性膀胱。方法:对81例患者采用双侧髂腰肌加强盆底肌,回肠去黏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例行锥状肌膀胱颈悬吊。术后3周,伤口愈合良好后,进行康复协调训练。随访患者术后尿失禁症状改善情况。结果:81例术后2周拔除尿管后,40例患儿尿前有尿意,尿流呈线状,两次排尿间隔在60min以上,膀胱最大容量、残余尿量、膀胱压力接近正常或正常,视为明显改善。23例患儿有尿意,尿流呈线状,两次排尿间隔时间在40min左右,膀胱最大容量、残余尿量较术前减少,膀胱压力增大,视为改善。18例无效,经过正规排尿训练后较前有改善。对9例进行膀胱尿道测压,膀胱压平均1.2kPa,尿道压平均1.15kPa,剩余尿30～50mL,最大容量300～600mL。81例患儿有63例得到严格随访,完整随访期6个月,其余部分随访资料不完整。63例被随访者中56例控尿明显改善,5例改善,2例无效,总有效率达到97%。结论:双侧髂腰肌加强盆底肌,回肠去黏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原性尿失禁的较好方法,配合术后排尿反射及控制训练对治疗效果影响明显。
BACKGROUND: Myelodysplasia caused by spina bifida is one of the most common neurodevelopmental deformities in children, and neurogenic urinary incontinence caused by it can seriously affect children’s quality of life. Objective: To observe the surgical treatment of hyperreflexic neurogenic incontinence and the effect of postoperative urination training. Design: before and after control, follow-up observation. Unit: First Affiliated Hospital of Zhengzhou University, Pediatric Surgery. PARTICIPANTS: A total of 81 patients with hyperreflexic neurogenic urinary incontinence were treated in our hospital from January 1992 to October 2000, including 54 males and 27 females, aged 4-14 years. Pelvic floor muscle relaxation and bladder capacity were confirmed preoperatively small. All patients were patients with neurogenic urinary incontinence and confirmed by urodynamic findings as hyperreflexic neurogenic bladder. Methods: Eighty-one patients underwent bilateral iliopsoas muscle strengthening pelvic floor muscle, ileum mucosa with vascular pedicle muscle patch on the basis of bladder augmentation for treatment, of which 5 cases of pyogenic bladder neck suspension . Three weeks after surgery, the wounds healed well and coordinated rehabilitation training. Follow-up patients with postoperative urinary incontinence symptoms improved. Results: After removal of the catheter in 81 cases 2 weeks after operation, 40 children had urinary excretion before urination, the urinary flow was linear, the urination interval was 60min or more, the maximal bladder volume, residual urine volume and bladder pressure were close to normal or normal , As significantly improved. 23 cases of children with urinary intention, urinary stream was linear, urination interval between two times in 40min, the maximum bladder capacity, residual urine volume decreased compared with preoperative, increased bladder pressure, as improved. Eighteen cases were ineffective and had improvement over the previous period after regular urination training. Bladder urethral pressure manometry was performed in 9 cases. The mean bladder pressure was 1.2 kPa. The average urethral pressure was 1.15 kPa. The residual urine was 30-50 mL. The maximum volume was 300-600 mL. Totally 63 cases of 81 children were followed up for a complete follow-up period of 6 months. The rest of the follow-up data were incomplete. Among the 63 follow-up cases, 56 cases showed marked improvement in urine control, 5 cases improved, 2 cases ineffective, and the total effective rate reached 97%. Conclusion: Bilateral iliopsoas muscle strengthening pelvic floor muscle, ileum mucosa with vascular pedicle muscle patch to strengthen the bladder detrusor basic bladder enlargement is the treatment of children with refractory neurogenic urinary incontinence is a good method, with Postoperative urination reflex and control training have a significant effect on the treatment.