CAJ | 학술논문

目的研究伴有排尿功能障碍的隐性脊柱裂患儿的尿动力学特征.方法对113例有排尿障碍的患儿进行尿动力学检查,其中48例经X线确诊为隐性脊柱裂者为观察组,无脊柱裂65例为对照组.检测项目包括:尿流率测定、充盈期膀胱压力容积测定、压力流率测定、同步括约肌肌电测定、静态尿道压力测定.比较两组间主要尿动力参数异常的发生率.观察组按主要临床症状分为尿失禁、尿频、单纯夜间遗尿和排尿困难4组,应用统计学研究临床症状与尿动力学主要参数的相关性.结果在检测中发现观察组48例中有46例有不同程度的异常.其中逼尿肌过度活动22例,排尿期逼尿肌活动低下和无收缩21例,最大尿流率降低18例,膀胱容积缩小15例,残余尿量增多12例,低顺应性膀胱7例,逼尿肌外括约肌协同失调4例,最大尿道压降低4例.观察组中逼尿肌过度活动、逼尿肌活动低下、残余尿量增多及低顺应性膀胱发生率更高.按临床症状来看,隐性脊柱裂伴有尿失禁的患儿更多的表现为逼尿肌活动低下及最大尿流率降低,尿频的患儿在尿动力检查中多表现为逼尿肌过度活动及残余尿增多,排尿困难的患儿逼尿肌活动低下的发生率更高,而遗尿的患儿更易检出逼尿肌过度活动.结论小儿隐性脊柱裂伴有排尿功能障碍的患儿具有多种尿动力学改变,且相同的症状可表现为不同类型的尿动力学异常,临床症状与尿动力学参数有一定的相关性,尿动力检查为其临床诊断和治疗方案制定提供重要客观依据.
목적 연구반유배뇨공능장애적은성척주렬환인적뇨동역학특정.방법 대113례유배뇨장애적환인진행뇨동역학검사,기중48례경X선학진위은성척주렬자위관찰조,무척주렬65례위대조조.검측항목포괄:뇨류솔측정、충영기방광압력용적측정、압력류솔측정、동보괄약기기전측정、정태뇨도압력측정.비교량조간주요뇨동력삼수이상적발생솔.관찰조안주요림상증상분위뇨실금、뇨빈、단순야간유뇨화배뇨곤난4조,응용통계학연구림상증상여뇨동역학주요삼수적상관성.결과 재검측중발현관찰조48례중유46례유불동정도적이상.기중핍뇨기과도활동22례,배뇨기핍뇨기활동저하화무수축21례,최대뇨류솔강저18례,방광용적축소15례,잔여뇨량증다12례,저순응성방광7례,핍뇨기외괄약기협동실조4례,최대뇨도압강저4례.관찰조중핍뇨기과도활동、핍뇨기활동저하、잔여뇨량증다급저순응성방광발생솔경고.안림상증상래간,은성척주렬반유뇨실금적환인경다적표현위핍뇨기활동저하급최대뇨류솔강저,뇨빈적환인재뇨동력검사중다표현위핍뇨기과도활동급잔여뇨증다,배뇨곤난적환인핍뇨기활동저하적발생솔경고,이유뇨적환인경역검출핍뇨기과도활동.결론 소인은성척주렬반유배뇨공능장애적환인구유다충뇨동역학개변,차상동적증상가표현위불동류형적뇨동역학이상,림상증상여뇨동역학삼수유일정적상관성,뇨동력검사위기림상진단화치료방안제정제공중요객관의거.
Objective To explore the urodynamic characteristics of spina bifida occulta (SBO) children with urinal dysfunction.Methods A total of 113 patients with urinal dysfunction,48 with SBO diagnosed radiologically and 65 negative controls were recruited.The major symptoms were incontinence,increased voiding frequency and dysuria and nocturnal enuresis.Uroflowmetry was conducted for all cases.And 112 of them received invasive urodynamic examinations for analyzing the correlation between main items of urodynamics and symptoms.Results Most (46/48) of them had various abnormalities on urodynamic test.There were detrusor instability (DI,n =22),detrusor underactivity (n =21),decreased maximum flow rate (n =18,Qmax),decreased bladder capacity (n =15),increased post-void residual urine (n =12,PVR),decreased bladder compliance (BC,n =7),detrusor-external sphincter dyssynergia (n=4) and decreased urethral pressure (n=4).DI,detrusor underactivity,increased PVR and decreased bladder compliance were more often present in patients with SBO.According to the symptoms,correlation existed between incontinence and decreased Qmax and detrusor underactivity; increased voiding frequency and increased PVR; dysuria and detrusor underactivity; nocturnal enuresis and DI.Conclusions SBO children with urinal dysfunction may have various urodynamic changes.And the same clinical manifestation may have different abnormalities.And the symptoms are probably correlated with urodynamic changes.