CAJ | 학술논문

目的评价保留膀胱黏膜的双层肠管浆肌层膀胱扩大术的远期疗效.方法病例选择条件:术前有明确支配膀胱的神经性损害,膀胱容量明显小于同龄儿童的正常值,同时伴有Ⅳ度以上膀胱输尿管反流,经过一段时间的口服抗胆碱能药物、清洁间歇导尿等保守治疗后,膀胱内压仍然较高,输尿管反流无明显改善,我们对符合上述条件的75例神经源性膀胱患儿行切除部分逼尿肌保留膀胱黏膜的双层肠浆肌层膀胱扩大术,同时根据患儿的具体情况选择性联合应用膀胱输尿管移植抗反流、膀胱颈紧缩、膀胱颈悬吊等手术方式,术后对患儿进行长期随访,对手术前后临床症状、肾脏功能、尿流动力学(膀胱容量、残余尿、逼尿肌压和顺应性)等方面进行评价.结果 75例手术患儿中68例获得随访,随访时间平均4.3年,术后无一例发生肾脏功能衰竭,45例获得一定的临床治疗改善.23例术后在尿流动力学、临床症状方面无明显改善.结论术后膀胱容量不能有效扩大是导致术后疗效不理想的重要原因,保留膀胱黏膜的双层肠浆肌层膀胱扩大术是治疗神经源性膀胱的一种方法,但该方法有待改进.
목적 평개보류방광점막적쌍층장관장기층방광확대술적원기료효.방법 병례선택조건:술전유명학지배방광적신경성손해,방광용량명현소우동령인동적정상치,동시반유Ⅳ도이상방광수뇨관반류,경과일단시간적구복항담감능약물、청길간헐도뇨등보수치료후,방광내압잉연교고,수뇨관반류무명현개선,아문대부합상술조건적75례신경원성방광환인행절제부분핍뇨기보류방광점막적쌍층장장기층방광확대술,동시근거환인적구체정황선택성연합응용방광수뇨관이식항반류、방광경긴축、방광경현조등수술방식,술후대환인진행장기수방,대수술전후림상증상、신장공능、뇨류동역학(방광용량、잔여뇨、핍뇨기압화순응성)등방면진행평개.결과 75례수술환인중68례획득수방,수방시간평균4.3년,술후무일례발생신장공능쇠갈,45례획득일정적림상치료개선.23례술후재뇨류동역학、림상증상방면무명현개선.결론 술후방광용량불능유효확대시도치술후료효불이상적중요원인,보류방광점막적쌍층장장기층방광확대술시치료신경원성방광적일충방법,단해방법유대개진.
Objective To evaluate the long-term outcome of bladder augmentation using double de-epithelialized segment of the small intestine lined with urothelium for the treatment of hyperreflexia neurogenical bladder.Methods Seventy eight patients,who underwent electromyogram of pelvic floor and be diagnosed with bladder nerve dysfunction,were enrolled in this study.The causes for the bladder nerve dysfunction on these patients were tethered cord syndrome,meningomyelocele,and intraspinal lipoma.All the children had taken conservative treatments such as anticholinergic medicine treatment and clean intermittent catheterization for a long time without any improvement of bladder capacity or vesicoureteral reflux.The surgical indications of these patients were neurogenical bladder,four degree vesicoureteral reflux,and smaller bladder than norrnal bladder volume.They underwent to enterocystoplasty using de-epithelialized segment of the intestine lined with urothelium.Some patients underwent Cohen operation,Leadbetter operation or Marshall-Marchettitype operation.Patient's kidney function,Urodynamic and clinical evaluation were followed up.Results Sixty eight patients were followed up for a mean period of 3.5 years.No renal failure happened.Forty five patients had improvements in their conditions,whose bladder volume,compliance and detrusor pressure were (321.80±98.54)ml,(11.08±2.57)ml/cmH2O,(30.34±12.28)cmH2O,respectively;and the other 23 patients had no improvements after surgery.Conclusions Bladder augmentation using double deepithelialized segment of the small intestine lined with urothelium achieved good outcomes on some patients with hyperreflexia neurogenical bladder.Bladder volume enlargement after surgery is the prognostic factor for the long term outcome.