CAJ | 학술논문

目的探讨小儿膀胱输尿管反流(vesicoureteric reflux,VUR)的尿动力学表现特点,为小儿VUR的诊断和治疗提供临床参考.方法选取在郑州大学第一附属医院小儿尿动力学中心就诊的VUR患儿87例(男58例,女29例);年龄4～12岁,平均6岁.另选取因下尿路症状就诊而尿动力学检查无异常且无VUR小儿60例(男38例,女22例)作为对照组;年龄4～12岁,平均6岁.将VUR患儿依据反流的程度分为轻度(Ⅰ度,15例)、中度(Ⅱ度和Ⅲ度,33例)、重度(Ⅳ度和Ⅴ度,39例).尿动力观察参数包括:最大尿流率、残余尿量、最大逼尿肌收缩压力、最大膀胱容量和膀胱顺应性.结果 VUR组的最大尿流率和最大膀胱容量分别为(6.8±6.3)ml/s和(138.5±73.9)ml,均明显低于对照组(16.1±6.7)ml/s和(285.5±107.5)ml,组间比较,差异有统计学意义(P＜0.05).VUR组残余尿量为(95.9±103.4)ml明显高于对照组(9.6±13.9)ml,差异有统计学意义(P＜0.05).VUR组最大逼尿肌压力为(41.6±22.2)cmH2O与对照组(35.1±13.0) cmH2O比较,差异无统计学意义(P-0.229).VUR组男、女童尿动力学参数差异无统计学意义(P＞0.05).VUR组轻度反流(15例)、中度反流(33例)和重度反流(39例)的最大膀胱容量分别为(121.83±69.94) ml、(163.73±80.81)ml和(123.58±68.70) ml,组间比较,差异无统计学意义(P＞0.05).轻度反流组顺应性正常12例(80％),中度反流组12例(36.4％),重度反流组9例(23.1％),三组间差异有统计学意义(P＜0.05).结论最大尿流率降低、最大膀胱容量减少、残余尿量增多和膀胱顺应性差可能是VUR发生的相关因素.
목적 탐토소인방광수뇨관반류(vesicoureteric reflux,VUR)적뇨동역학표현특점,위소인VUR적진단화치료제공림상삼고.방법 선취재정주대학제일부속의원소인뇨동역학중심취진적VUR환인87례(남58례,녀29례);년령4～12세,평균6세.령선취인하뇨로증상취진이뇨동역학검사무이상차무VUR소인60례(남38례,녀22례)작위대조조;년령4～12세,평균6세.장VUR환인의거반류적정도분위경도(Ⅰ도,15례)、중도(Ⅱ도화Ⅲ도,33례)、중도(Ⅳ도화Ⅴ도,39례).뇨동력관찰삼수포괄:최대뇨류솔、잔여뇨량、최대핍뇨기수축압력、최대방광용량화방광순응성.결과 VUR조적최대뇨류솔화최대방광용량분별위(6.8±6.3)ml/s화(138.5±73.9)ml,균명현저우대조조(16.1±6.7)ml/s화(285.5±107.5)ml,조간비교,차이유통계학의의(P＜0.05).VUR조잔여뇨량위(95.9±103.4)ml명현고우대조조(9.6±13.9)ml,차이유통계학의의(P＜0.05).VUR조최대핍뇨기압력위(41.6±22.2)cmH2O여대조조(35.1±13.0) cmH2O비교,차이무통계학의의(P-0.229).VUR조남、녀동뇨동역학삼수차이무통계학의의(P＞0.05).VUR조경도반류(15례)、중도반류(33례)화중도반류(39례)적최대방광용량분별위(121.83±69.94) ml、(163.73±80.81)ml화(123.58±68.70) ml,조간비교,차이무통계학의의(P＞0.05).경도반류조순응성정상12례(80％),중도반류조12례(36.4％),중도반류조9례(23.1％),삼조간차이유통계학의의(P＜0.05).결론 최대뇨류솔강저、최대방광용량감소、잔여뇨량증다화방광순응성차가능시VUR발생적상관인소.
Objective To explore the urodynamic features of children with vesicoureteral reflux (VUR) so as to provide clinical reference for its diagnosis and treatment.Methods A total of 87 cases [58 boys,29 girls,aged 6(4-12)] with a diagnosis of VUR were selected as VUR group (group Ⅰ) while 60 non-VUR children with normal urodynamics due to lower urinary tract symptoms [38 boys,22 girls,aged 7(4-12)] as control group (group Ⅱ).All VUR children were classified into 3 categories on the basis of voiding cystourethrogram (VCUG),i.e.mild (grade Ⅰ,n=15),moderate (grade Ⅱ,n =14; grade Ⅲ,n=19) and severe (grade Ⅳ,n =23; grade Ⅴ,n =16).Such urodynamic parameters as maximum flow rate (MFR),post voiding residual urine volume (PVR),maximum detrusor pressure (Pdet.maxi),maximum bladder capacity (MBC) and bladder compliance (BC) were recorded.Results MFR and MBC in VUR group were significant lower than those in control group [(6.8 ± 6.3) vs (16.1 ±6.7) ml/s,(138.5±73.9) vs (285.5 ± 107.5) ml,P＜0.05] and PVR was higher than that in the control group [(95.9 ± 103.4) vs (9.6 ± 13.9) ml,P＜0.05].No significant difference in Pdet.maxi between two groups.The parameters between boys and girls in VUR group had no statistical significance (P＞0.05).MBC in mild VUR group (n=15),moderate VUR group (n =33) and severe VUR group (n =39) (121.83 ± 69.94 vs 163.73 ± 80.81 vs 123.58 ± 68.70 ml) had no statistical significance (P＞0.05).BC less than 20 ml/cmH2O was defined with poor compliance.There were 12cases (80％ or 12/15) in mild VUR group with normal BC,but 12 (36.4％ or 12/33) in moderate and 9 in severe VUR group (23.1％ or 9/39).And the difference was significant (P＜0.05).Conclusions Lower MFR,decreased MBC,higher PVR and poor BC may contribute to the occurrences of VUR in children.