脊髓栓系综合征对上尿路的影响及其机制
척수전계종합정대상뇨로적영향급기궤제
Influence of tethered cord syndrome on the upper urinary tract and its etiology
  • 万方数据
    中华泌尿外科杂志 중화비뇨외과잡지
    CHINESE JOURNAL OF UROLOGY
    2008年 9期 635-638 ,共4页

    曾健文%谢克基%姜粹平%潘朝杰%钟惟德%王良圣%魏鸿蔼

    증건문%사극기%강수평%반조걸%종유덕%왕량골%위홍애

    脊髓栓系综合征%膀胱,神经原性%尿动力学%肾损害 脊髓栓繫綜閤徵%膀胱,神經原性%尿動力學%腎損害
    척수전계종합정%방광,신경원성%뇨동역학%신손해
    Tethered cord syndrome%Bladder,neurogenic%Urodynamies%Renal deterio-ration
    目的 探讨脊髓栓系综合征(TCS)对上尿路的影响及其机制. 方法经脊髓MRI确诊的TCS患者40例.男21例,女19例.平均年龄23岁.病程1～40年.行尿液分析及中段尿培养、血肌酐(SCr)测定、泌尿系B超、IVU、膀胱造影及尿动力学检查,评价TCS对上尿路的影响.将有无SCr升高、肾积水、膀胱输尿管反流(VUR)界定为是否有上尿路损害. 结果 40例患者中有尿路感染17例(42.5%),SCr异常升高[(251.6±98.5)μmol/16例.B超检查(29例)示双肾积水、双侧输尿管上段扩张12例(41.4%).IVU检查(30例)示肾、输尿管扩张、积水10例(33.3%),膀胱形态异常22例(73.3%),有较多憩室及小梁形成.逆行造影(22例)示VUR 17例(77.3%)27侧.31例(31/35)有残余尿(261.8±232.4)ml.33例膀胱压力容积测定示储尿期最大逼尿肌压(41.2±20.9)cm Hz0(1 cm H2O=0.098 kPa),顺应性(22.3±18.8)ml/cm H20.33例行压力一流率及肌电图测定示排尿期出现逼尿肌-外括约肌协同失调者16例(48.5%),逼尿肌无反射16例(48.5%),逼尿肌反射减弱13例(39.4%).16例成人行静态尿道压力描记,最大尿道闭合压(76.1±33.1)cm H2O.20例有上尿路损害者与20例无上尿路损害者中逼尿肌顺应性分别为(9.4±7.8)和(19.3±15.8)ml/cm H2O、储尿期最大逼尿肌压分别为(43.1±21.2)和(24.0±11.9)cm H2O、残余尿量分别为(189.0±138.0)和(47.8±36.8)ml、最大尿道闭合压分别为(86.2±32.4)和(46.8±20.8)cm H2O、发生逼尿肌收缩力受损分别为20/20和9/13、发生逼尿肌一外括约肌协同失调分别为13/20和3/13,2组比较差异均有统计学意义(P<0.05).17例VUR者中16例发生尿路感染,5例无VUR者仅1例发生尿路感染,二者比较差异有统计学意义(P=0.003).17例尿路感染者中15例发生上尿路损害,23例无尿路感染者5例发生上尿路损害,二者比较差异有统计学意义(P=0.000). 结论 TCS患者逼尿肌顺应性降低、储尿期逼尿肌压升高、残余尿量增多、最大尿道闭合压升高、逼尿肌收缩力受损、逼尿肌一外括约肌协同失调是上尿路损害的危险因素.
    목적 탐토척수전계종합정(TCS)대상뇨로적영향급기궤제. 방법경척수MRI학진적TCS환자40례.남21례,녀19례.평균년령23세.병정1～40년.행뇨액분석급중단뇨배양、혈기항(SCr)측정、비뇨계B초、IVU、방광조영급뇨동역학검사,평개TCS대상뇨로적영향.장유무SCr승고、신적수、방광수뇨관반류(VUR)계정위시부유상뇨로손해. 결과 40례환자중유뇨로감염17례(42.5%),SCr이상승고[(251.6±98.5)μmol/16례.B초검사(29례)시쌍신적수、쌍측수뇨관상단확장12례(41.4%).IVU검사(30례)시신、수뇨관확장、적수10례(33.3%),방광형태이상22례(73.3%),유교다게실급소량형성.역행조영(22례)시VUR 17례(77.3%)27측.31례(31/35)유잔여뇨(261.8±232.4)ml.33례방광압력용적측정시저뇨기최대핍뇨기압(41.2±20.9)cm Hz0(1 cm H2O=0.098 kPa),순응성(22.3±18.8)ml/cm H20.33례행압력일류솔급기전도측정시배뇨기출현핍뇨기-외괄약기협동실조자16례(48.5%),핍뇨기무반사16례(48.5%),핍뇨기반사감약13례(39.4%).16례성인행정태뇨도압력묘기,최대뇨도폐합압(76.1±33.1)cm H2O.20례유상뇨로손해자여20례무상뇨로손해자중핍뇨기순응성분별위(9.4±7.8)화(19.3±15.8)ml/cm H2O、저뇨기최대핍뇨기압분별위(43.1±21.2)화(24.0±11.9)cm H2O、잔여뇨량분별위(189.0±138.0)화(47.8±36.8)ml、최대뇨도폐합압분별위(86.2±32.4)화(46.8±20.8)cm H2O、발생핍뇨기수축력수손분별위20/20화9/13、발생핍뇨기일외괄약기협동실조분별위13/20화3/13,2조비교차이균유통계학의의(P<0.05).17례VUR자중16례발생뇨로감염,5례무VUR자부1례발생뇨로감염,이자비교차이유통계학의의(P=0.003).17례뇨로감염자중15례발생상뇨로손해,23례무뇨로감염자5례발생상뇨로손해,이자비교차이유통계학의의(P=0.000). 결론 TCS환자핍뇨기순응성강저、저뇨기핍뇨기압승고、잔여뇨량증다、최대뇨도폐합압승고、핍뇨기수축력수손、핍뇨기일외괄약기협동실조시상뇨로손해적위험인소.
    Objective To investigate the influence of tethered cord syndrome (TCS) on the up-per urinary tract and its etiology. Methods Forty patients with TCS diagnosed by spinal MRI were enrolled in this study. There were 21 males and 19 females with mean age of 23 years old. The course of disease ranged from 1 to 40 years. Urinalysis, mid-stream urine culture, serum creatinine(SCr), urinary system ultrasound, IVU, eystography and urodynamic study were carried out on all patients. Results Urinary tract infection was found in 17 patients and increased level of SCr was found in 6 pa-tients (251.64±98.5μmol/L). Of the 29 patients who underwent urinary system ultrasound examina-tion, 12 cases had hydronephroais and dilated upper ureter. Of the 30 patients who underwent IVU, 10(33.3%) had ureterectasia and hydronephrosis, 22 cases had bladder turriform or Christmas tree like deformity with diverticulum and trabeculum. Of the 22 patients accepted cystography, 17 cases had vesieoureteral reflux on 27 sides. Post-void residual (PVR) was evaluated in 35 patients and found increased in 31 cases. Cystometry had been done in 33 patients. The mean value of maximal detrusor pressure (Pdetmax) during filling phase was 41.2±20.9 cm H2O. The detrusor compliance was 22.35±18.8 ml/cm H2O. During voiding phase, detrusor-sphincter dyssynergia(DSD)was observed in 16 patients, detrusor areflexia was observed in 16 patients and detrusor underactivity was observed in 13 patients. Resting urethral pressure profilemetry was measured in 16 patients. Maximal urethral closure pressure (MUCP) was 76.1±33.1 cm H2O. The upper urinary tract deterioration was de-fined as increased SCr, hydronephrosis or vesicoureteral reflux. There were 20 patients diagnosed as upper urinary tract deterioration. The compliance of the upper urinary tract deteriorating group and the no-deteriorating group was 9.4±7.8 vs 19.3±15.8 ml/cm H2O, Pdetmax was 43.1±21.2 vs 24.0±11.9 cm H2O, PVR 189.0±138.0 vs 47.8±36.8 ml, MUCP 86.2±32.4 vs 46.8 5±20.8 cm H2O, incidence of damaged detrusor 100.0% vs 69.2% and DSD 65.0% vs 23.1%, respectively. There were significant differences between the 2 groups(P<0.05). And when comparing the VUR group with no VUR group, the incidence of urinary tract infection was 94.1%(16/17) vs 20.0%(1/ 5) (P=0.003). And when comparing urinary tract infection group with no infection group, the inci-dence of upper urinary tract deterioration was 88.2% (15/17) vs 21.7%(5/23)(P=0.000). Condn-sion Low compliance bladder, high Pdetmax during filling phase, increased PVR, high MUCP, damage of detrusor contractive function and DSD are the risk factors for upper urinary tract deteriora-tion in the TCS patients.
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