中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2012年
10期
1010-1014
,共5页
齐林%芦山%吕强%冯书彬%董留建
齊林%蘆山%呂彊%馮書彬%董留建
제림%호산%려강%풍서빈%동류건
儿童%脊髓脊膜膨出%脊髓栓系综合征%外科手术%随访研究
兒童%脊髓脊膜膨齣%脊髓栓繫綜閤徵%外科手術%隨訪研究
인동%척수척막팽출%척수전계종합정%외과수술%수방연구
Child%Meningomyelocele%Tethered cord syndrome%Surgical procedures,operative%Follow - up studies
目的 评估脊髓脊膜膨出合并脊髓栓系综合征(TCS)患儿手术后的治疗效果,来确定影响预后的决定性因素.方法 收集2003 - 2007年郑州市儿童医院收治153例脊髓脊膜膨出合并TCS患儿的临床数据,男62例,女91例.通过手术前后症状、体征的改善情况以及辅助检查(如:CT、MRI、泌尿系彩超、尿动力学检查等),对患儿术后恢复情况进行综合评估.结果 (1)大小便改善:术前便秘37例,术后便秘18例;术前大便失禁27例,术后大便失禁13例;术前尿潴留23例,术后尿潴留5例;术前尿失禁34例,术后尿失禁7例;(2)足部畸形及下肢轻瘫:术前101例,术后3年随访77例患儿术后足部畸形得到明显改善,24例患儿无改善(P=0.01);(3)膀胱功能恢复情况:28例术前神经源性膀胱患儿,术后20例膀胱顺应性和最大膀胱压测定容量明显改善(P<0.05).5例单侧肾脏集合系统分离患儿术后半年及1-3年随访,肾脏集合系统分离明显改善.结论 脊髓病变的严重程度、手术是否完全得到松解以及早期手术、术后长期功能锻炼都是影响预后的重要因素,而是否早期手术对预后的影响尤为重要.
目的 評估脊髓脊膜膨齣閤併脊髓栓繫綜閤徵(TCS)患兒手術後的治療效果,來確定影響預後的決定性因素.方法 收集2003 - 2007年鄭州市兒童醫院收治153例脊髓脊膜膨齣閤併TCS患兒的臨床數據,男62例,女91例.通過手術前後癥狀、體徵的改善情況以及輔助檢查(如:CT、MRI、泌尿繫綵超、尿動力學檢查等),對患兒術後恢複情況進行綜閤評估.結果 (1)大小便改善:術前便祕37例,術後便祕18例;術前大便失禁27例,術後大便失禁13例;術前尿潴留23例,術後尿潴留5例;術前尿失禁34例,術後尿失禁7例;(2)足部畸形及下肢輕癱:術前101例,術後3年隨訪77例患兒術後足部畸形得到明顯改善,24例患兒無改善(P=0.01);(3)膀胱功能恢複情況:28例術前神經源性膀胱患兒,術後20例膀胱順應性和最大膀胱壓測定容量明顯改善(P<0.05).5例單側腎髒集閤繫統分離患兒術後半年及1-3年隨訪,腎髒集閤繫統分離明顯改善.結論 脊髓病變的嚴重程度、手術是否完全得到鬆解以及早期手術、術後長期功能鍛煉都是影響預後的重要因素,而是否早期手術對預後的影響尤為重要.
목적 평고척수척막팽출합병척수전계종합정(TCS)환인수술후적치료효과,래학정영향예후적결정성인소.방법 수집2003 - 2007년정주시인동의원수치153례척수척막팽출합병TCS환인적림상수거,남62례,녀91례.통과수술전후증상、체정적개선정황이급보조검사(여:CT、MRI、비뇨계채초、뇨동역학검사등),대환인술후회복정황진행종합평고.결과 (1)대소편개선:술전편비37례,술후편비18례;술전대편실금27례,술후대편실금13례;술전뇨저류23례,술후뇨저류5례;술전뇨실금34례,술후뇨실금7례;(2)족부기형급하지경탄:술전101례,술후3년수방77례환인술후족부기형득도명현개선,24례환인무개선(P=0.01);(3)방광공능회복정황:28례술전신경원성방광환인,술후20례방광순응성화최대방광압측정용량명현개선(P<0.05).5례단측신장집합계통분리환인술후반년급1-3년수방,신장집합계통분리명현개선.결론 척수병변적엄중정도、수술시부완전득도송해이급조기수술、술후장기공능단련도시영향예후적중요인소,이시부조기수술대예후적영향우위중요.
Objective This study was to assess the long - term results of surgical treatment of meningomyelocele with TCS in children and to define any prognostic factors associated with longterm outcome.Methods Between 2003 to 2007,153 children with TCS were analyzed.The group included 62 boys and 91 girls.Evaluation was performed through the symptoms,signs and auxiliary examination ( color dopplar ultrasound,urinedynamics ).Results Constipation ( preoperative 37,postoperative 18 ),fecal incontinence (preoperative 27,postoperative 4 ),urinary - retention ( preoperative23,postoperative5 ),urinary incontinence (preoperative 34,postoperative 7) were found.Lower limb paralysis was found in 101 cases before surgery and in 24 cases after surgery ( P =0.01 ).Bladder compliance and the capacity in maximum bladder pressure determination were obviously improved ( P < 0.05 ).Kidney collecting system separation was improved obviously.Conclusion Early surgery is the key factor which affects the outcome.