中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
9期
655-659
,共5页
张帆%廖利民%付光%吴娟%梁文立%李东%熊宗胜%韩春生%鞠彦合%史文博
張帆%廖利民%付光%吳娟%樑文立%李東%熊宗勝%韓春生%鞠彥閤%史文博
장범%료이민%부광%오연%량문립%리동%웅종성%한춘생%국언합%사문박
肠道膀胱扩大术%输尿管再植%神经源性膀胱%尿动力学
腸道膀胱擴大術%輸尿管再植%神經源性膀胱%尿動力學
장도방광확대술%수뇨관재식%신경원성방광%뇨동역학
Augmentation enterocystoplasty%Ureteral reimplantation%Neurogenic bladder dysfunction%Urodynamies
目的 探讨肠道膀胱扩大术治疗神经源性膀胱的疗效. 方法 2005-2011年对77例肠道膀胱扩大术患者(乙状结肠膀胱扩大术74例,回肠膀胱扩大术3例)随访2年,对术后并发症、肾功能、尿动力学检查参数及患者生活质量进行观察评价. 结果 截止24个月随访期,患者最大膀胱测压容积较术前显著增加[(160.6 ±128.3)与(468.5±60.6)ml,P＜0.001],最大逼尿肌压力显著降低[ (31.1±26.4)与(10.9±4.5)cm H20,P=0.002],血肌酐水平显著降低[(270.3±113.6)与(174.4±81.3)μmol/L,P=0.001].与术前相比,患者每口尿垫使用数量及尿失禁次数显著减少(P＜0.01).术后发生代谢性酸中毒2例(2.6％),粘连性肠梗阻4例(5.2％),肾衰竭1例(1.2％),输尿管反流复发3例(3.9％). 结论 肠道膀胱扩大术可有效保护患者的上尿路功能,对于神经源性膀胱病史较长、低压反流及上尿路明显扩张患者可同期行输尿管再植,有利于中、重度肾功能不全患者的上尿路功能恢复.
目的 探討腸道膀胱擴大術治療神經源性膀胱的療效. 方法 2005-2011年對77例腸道膀胱擴大術患者(乙狀結腸膀胱擴大術74例,迴腸膀胱擴大術3例)隨訪2年,對術後併髮癥、腎功能、尿動力學檢查參數及患者生活質量進行觀察評價. 結果 截止24箇月隨訪期,患者最大膀胱測壓容積較術前顯著增加[(160.6 ±128.3)與(468.5±60.6)ml,P＜0.001],最大逼尿肌壓力顯著降低[ (31.1±26.4)與(10.9±4.5)cm H20,P=0.002],血肌酐水平顯著降低[(270.3±113.6)與(174.4±81.3)μmol/L,P=0.001].與術前相比,患者每口尿墊使用數量及尿失禁次數顯著減少(P＜0.01).術後髮生代謝性痠中毒2例(2.6％),粘連性腸梗阻4例(5.2％),腎衰竭1例(1.2％),輸尿管反流複髮3例(3.9％). 結論 腸道膀胱擴大術可有效保護患者的上尿路功能,對于神經源性膀胱病史較長、低壓反流及上尿路明顯擴張患者可同期行輸尿管再植,有利于中、重度腎功能不全患者的上尿路功能恢複.
목적 탐토장도방광확대술치료신경원성방광적료효. 방법 2005-2011년대77례장도방광확대술환자(을상결장방광확대술74례,회장방광확대술3례)수방2년,대술후병발증、신공능、뇨동역학검사삼수급환자생활질량진행관찰평개. 결과 절지24개월수방기,환자최대방광측압용적교술전현저증가[(160.6 ±128.3)여(468.5±60.6)ml,P＜0.001],최대핍뇨기압력현저강저[ (31.1±26.4)여(10.9±4.5)cm H20,P=0.002],혈기항수평현저강저[(270.3±113.6)여(174.4±81.3)μmol/L,P=0.001].여술전상비,환자매구뇨점사용수량급뇨실금차수현저감소(P＜0.01).술후발생대사성산중독2례(2.6％),점련성장경조4례(5.2％),신쇠갈1례(1.2％),수뇨관반류복발3례(3.9％). 결론 장도방광확대술가유효보호환자적상뇨로공능,대우신경원성방광병사교장、저압반류급상뇨로명현확장환자가동기행수뇨관재식,유리우중、중도신공능불전환자적상뇨로공능회복.
Objective To assess clinical and urodynamic results of augmentation enterocystoplasty (AE) in patients with ncurogcnic hladdcr dysfunction (NBD).Methods Retrospectively reviewed our database between 2005-2011 to identify 77 patients who underwent AE ( sigmoid 74 patients,ileum 3 patients).Postoperativc complications,renal function,urodynamics parameters and quality of daily life were evaluated.Results The mean follow-up length was 24 months.Compared with pre-operative condition,the mean bladder capacity significantly increased from (160.6 ± 128.3) to (468.5 ± 60.6) ml (P ＜0.001 ) and the maximum detrusor pressure decreased from ( 31.1 ± 26.4) to ( 10.9 ± 4.5 ) cm H2O ( P =0.002 ).Serum creatinine level decreased from (270.3 ± 113.6 ) to ( 174.4 ± 81.3 ) μmol/(l) ( P =0.00 1 ).There were significant decrease on mean number of incontinence episodes and pads used per day ( P ＜0.01 ).Post-operative complications included metabolic acidosis in two patients (2.6％),adhesive intestinal obstruction in four patients (5.2％),deteriorating renal function in one patients ( 1.2％ ) and recurrence of vesicoureteral reflux in three patients (3.9％).Conclusions The results suggest that AE is safe and effective in treating patients with NBD.Concomitant URI is considerèd on patients with long illness history,vesicoureteral reflux at low intravesical pressures and upper urinary tract dilation.Patients with moderate and severe upper urinary tract deteriorations benefit from this procedure and the benefit can maintain a long time.
