CAJ | 학술논문

目的通过尿动力学检测评价小儿膀胱横纹肌肉瘤(rhabdomyosarcoma,RMS)术后膀胱功能恢复情况,以指导临床用药及膀胱功能训练,促进膀胱功能恢复,减少并发症.方法收集2003年8月至2013年8月间收治的12例膀胱RMS患儿的临床资料及排尿日记并实施尿动力学检测,依据其检测结果指导膀胱功能训练,包括盆底肌肉训练、尿意习惯训练及指导临床用药,并对影响术后膀胱功能恢复相关因素进行分析.结果本组术后行尿动力学检查并指导膀胱功能训练,除1例复发死亡外,11例中膀胱控尿功能良好9例,白天排尿间隔时间1～3 h,夜间排尿0～2次;压力性尿失禁1例,白天排尿间隔时间30～40 min,夜间排尿2～3次;另1例尚在膀胱训练治疗中.最后一次尿动力学检测见膀胱内压、最大膀胱测压容量、残余尿量、尿流率、膀胱顺应性均正常9例;1例术后伴压力性尿失禁,通过膀胱功能训练,现最大膀胱测压容量约135 ml,为最小膀胱容量估计值的90％,而残余尿量、膀胱内压、尿流率未见明显异常,膀胱控尿功能有所改善;另1例术后6个月,最大膀胱测压容量偏小,膀胱顺应性偏低,正进行膀胱功能训练.结论膀胱RMS患儿术后,虽使用化疗药物,但膀胱功能未受到明显不利影响;尿动力学检测能准确评价膀胱RMS术后膀胱功能恢复情况,用于指导术后膀胱功能训练及用药,对促进术后膀胱功能的康复具有重要的临床意义.
목적 통과뇨동역학검측평개소인방광횡문기육류(rhabdomyosarcoma,RMS)술후방광공능회복정황,이지도림상용약급방광공능훈련,촉진방광공능회복,감소병발증.방법 수집2003년8월지2013년8월간수치적12례방광RMS환인적림상자료급배뇨일기병실시뇨동역학검측,의거기검측결과지도방광공능훈련,포괄분저기육훈련、뇨의습관훈련급지도림상용약,병대영향술후방광공능회복상관인소진행분석.결과 본조술후행뇨동역학검사병지도방광공능훈련,제1례복발사망외,11례중방광공뇨공능량호9례,백천배뇨간격시간1～3 h,야간배뇨0～2차;압력성뇨실금1례,백천배뇨간격시간30～40 min,야간배뇨2～3차;령1례상재방광훈련치료중.최후일차뇨동역학검측견방광내압、최대방광측압용량、잔여뇨량、뇨류솔、방광순응성균정상9례;1례술후반압력성뇨실금,통과방광공능훈련,현최대방광측압용량약135 ml,위최소방광용량고계치적90％,이잔여뇨량、방광내압、뇨류솔미견명현이상,방광공뇨공능유소개선;령1례술후6개월,최대방광측압용량편소,방광순응성편저,정진행방광공능훈련.결론 방광RMS환인술후,수사용화료약물,단방광공능미수도명현불리영향;뇨동역학검측능준학평개방광RMS술후방광공능회복정황,용우지도술후방광공능훈련급용약,대촉진술후방광공능적강복구유중요적림상의의.
Objective To evaluate the postoperative bladder function by urodynamic studies in children with bladder rhabdomyosarcoma (RMS) so as to guide the clinical rational drug use,facilitate the training of bladder function,promote the recovery of bladder function and reduce the complications.Methods The voiding diary and clinical data of 12 children patients with bladder RMS were collected and urodynamic studies performed from August 2003 to August 2013.According to the urodynamic results,bladder function training was conducted,including pelvic floor muscle and toilet training.The relevant influencing factors of bladder function were analyzed.Results A total of 12 children with bladder RMS was treated and postoperative urodynamic studies were performed routinely.Except for one mortality,the remainder had event-free survival.Urinary continence was preserved in 9 cases with diurnal urination intervals between 1-3 hours and nocturnal urination at 0-2 times.Stress urinary incontinence occurred in 1 patient with diurnal urination intervals between 30-40min and nocturnal urination at 2-3 times.The last one received bladder function training.The final urodynamic results,including bladder pressure,maximum cystometric capacity (MCC),residual urine volume,flow rate and bladder compliance of 9 cases were all normal after the final chemotherapy course.One case of stress urinary incontinence improved by bladder function training.MCC was approximately 135 ml (90％ of minimal calculated bladder capacity) and residual urine volume,bladder pressure and flow rate were all normal.MCC and bladder compliance decreased in one child for 6months after operation and the child underwent training.Conclusions After operation,there is no obvious adverse effect on bladder function in children with bladder RMS on chemotherapy.Urodynamic studies may accurately evaluate the postoperative bladder function,guide functional training and clinical medication and improve bladder function.