CAJ | 학술논문

目的探讨去黏膜带蒂回肠膀胱扩大术联合髂腰肌盆底肌加强术治疗神经源性膀胱的疗效.方法前瞻性研究去黏膜带蒂回肠膀胱扩大联合髂腰肌盆底肌加强术治疗神经源性膀胱的疗效.神经源性膀胱患者12例.男9例,女3例.年龄18 ～ 27岁,平均25岁.临床表现为不同程度的尿失禁.病程6 ～ 64个月,平均23个月.应用超声、膀胱造影、尿动力学等检查前瞻性比较术前和术后1年的尿动力学参数,上尿路形态和肾功能情况.结果 12例手术顺利.术后出现切口延迟愈合2例,肠梗阻1例,膀胱腹壁尿瘘1例,未出现黏液尿.术后1年1例因发热性泌尿系感染行自我清洁间歇导尿,11例为腹压排尿.术前膀胱输尿管反流8例,术后反流消失5例,反流程度改善3例.术前肾功能不全5例,术后血肌酐水平下降至正常范围3例.术前和术后1年最大膀胱压测定容量[( 247±27)和(412±32) ml]、膀胱顺应性[(4.4±1.2)和(26.2±4.0)ml/cm H2O,1 cm H2O =0.098 kPa]、相对安全容量[(206±24)和(368±26) ml]、最大尿流率[(11±2)和(20±3)ml/s]、残余尿量[(136±25)和(26±8)ml]、逼尿肌漏点压[(63.1±4.9)和(17.8±3.6)cm H2O]比较差异均有统计学意义(P＜0.05).结论去黏膜带蒂同肠浆肌层膀胱扩大联合髂腰肌盆底肌加强术可有效治疗神经源性膀胱.
목적 탐토거점막대체회장방광확대술연합가요기분저기가강술치료신경원성방광적료효.방법 전첨성연구거점막대체회장방광확대연합가요기분저기가강술치료신경원성방광적료효.신경원성방광환자12례.남9례,녀3례.년령18 ～ 27세,평균25세.림상표현위불동정도적뇨실금.병정6 ～ 64개월,평균23개월.응용초성、방광조영、뇨동역학등검사전첨성비교술전화술후1년적뇨동역학삼수,상뇨로형태화신공능정황.결과 12례수술순리.술후출현절구연지유합2례,장경조1례,방광복벽뇨루1례,미출현점액뇨.술후1년1례인발열성비뇨계감염행자아청길간헐도뇨,11례위복압배뇨.술전방광수뇨관반류8례,술후반류소실5례,반류정도개선3례.술전신공능불전5례,술후혈기항수평하강지정상범위3례.술전화술후1년최대방광압측정용량[( 247±27)화(412±32) ml]、방광순응성[(4.4±1.2)화(26.2±4.0)ml/cm H2O,1 cm H2O =0.098 kPa]、상대안전용량[(206±24)화(368±26) ml]、최대뇨류솔[(11±2)화(20±3)ml/s]、잔여뇨량[(136±25)화(26±8)ml]、핍뇨기루점압[(63.1±4.9)화(17.8±3.6)cm H2O]비교차이균유통계학의의(P＜0.05).결론 거점막대체동장장기층방광확대연합가요기분저기가강술가유효치료신경원성방광.
Objective To assess the outcome of de-epithelialied ileocystoplasty combined with strengthened pelvic floor in patients with neurogenic bladder.Methods Twelve patients (9 male,3 female) aged from 18 -27 years (averaged 25 years) with neurogenic bladder received de-mucosalized seromuscular ileocystoplasty combined with strengthened pelvic floor,and were evaluated by urodynamic parmeters,upper urinary tract image appearance,and serum creatinine before and one year after operation.Results After operation,the max cystometric capacity (412 ± 32 ml),bladder compliance (26.2 ± 4.0ml/H2O),relative safety cystometric capacity (368 ±26 ml) and max flow rate (20 ±3 ml/s) were respectively significantly higher than those preoperation(247 ±27 ml,4.4 ± 1.2 ml/cm H2O,206 ±24 ml,11 ±2ml/s,P ＜ 0.05).Moreover,the post voided residual (26 ± 8 ml) and detmsor leakage point pressure (17.8 ±3.6 cm H2O) were significantly lower than those of preoperation (136 ± 25 ml,63.1 ± 4.9cm H2O,P ＜0.05).The vesicoureteral reflux disappeared in five (63％) cases,and was relieved in the remaining three cases.Of the five cases with renal insufficiency,three (60％) cases had normal serum creatinine level,none had increased serum creatinine levels.After operation,late healing occurred in two ( 17％ ) cases,intestinal obstruction in one (8％),vesicoabdominal fistula in one (8％),and no cases had mucous urine.Clean intermittent self-catheterization was performed in one case (8％) to empty the bladder due to a fever resulting from urinary tract infection,the remaining 12 (92％) cases could empty their bladders through abdominal pressure.Conclusions De-mucosalized seromuscular ileocystoplasty combined with strengthened pelvic floor results in a good outcome for the patients with neurogenic bladder.