CAJ | 학술논문

目的：评价不同严重程度神经性膀胱患儿的治疗方法和结果。方法2013年4月至2014年1月我们收治神经性膀胱患儿15例，男7例，女8例，年龄1～13岁，均有脊膜膨出修补术病史。全部患儿行尿动力学检查、泌尿系超声和排泄性膀胱尿道造影。尿动力学检查显示9例合并逼尿肌压升高，12例合并膀胱容量减少，7例合并逼尿肌过度活动；泌尿系超声和排泄性膀胱尿道造影显示8例合并肾积水和输尿管扩张，7例合并输尿管反流。5例行手术治疗，其中1例行小肠膀胱扩大及输尿管抗反流术，2例行逼尿肌部分切除膀胱扩大术及输尿管抗反流术，1例行小肠膀胱扩大术，1例行输尿管抗反流术，术后配合清洁间歇导尿。其余10例行清洁间歇导尿，4例同时口服索利那新。结果2例小肠膀胱扩大术后膀胱容量明显增加，逼尿肌压明显下降，输尿管反流消失；2例逼尿肌部分切除膀胱扩大术者膀胱容量略有增加，逼尿肌压略有下降，仍存在输尿管反流。1例输尿管抗反流者反流消失。保守治疗患儿中，膀胱容量在正常容量的2／3以上且逼尿肌压较低的6例患儿中，2例尿失禁消失，2例失禁较前明显减轻，2例无改善；膀胱容量不足正常1／2，逼尿肌压较高的4例患儿中，尿失禁及输尿管反流无明显减轻；4例应用索立那新后逼尿肌过度活动明显减轻。结论尿动力学检查泌尿系超声和排泄性膀胱尿道造影是评价神经性膀胱的重要手段，神经性膀胱患儿要根据其评价结果采取个性化的治疗方案。
목적：평개불동엄중정도신경성방광환인적치료방법화결과。방법2013년4월지2014년1월아문수치신경성방광환인15례，남7례，녀8례，년령1～13세，균유척막팽출수보술병사。전부환인행뇨동역학검사、비뇨계초성화배설성방광뇨도조영。뇨동역학검사현시9례합병핍뇨기압승고，12례합병방광용량감소，7례합병핍뇨기과도활동；비뇨계초성화배설성방광뇨도조영현시8례합병신적수화수뇨관확장，7례합병수뇨관반류。5례행수술치료，기중1례행소장방광확대급수뇨관항반류술，2례행핍뇨기부분절제방광확대술급수뇨관항반류술，1례행소장방광확대술，1례행수뇨관항반류술，술후배합청길간헐도뇨。기여10례행청길간헐도뇨，4례동시구복색리나신。결과2례소장방광확대술후방광용량명현증가，핍뇨기압명현하강，수뇨관반류소실；2례핍뇨기부분절제방광확대술자방광용량략유증가，핍뇨기압략유하강，잉존재수뇨관반류。1례수뇨관항반류자반류소실。보수치료환인중，방광용량재정상용량적2／3이상차핍뇨기압교저적6례환인중，2례뇨실금소실，2례실금교전명현감경，2례무개선；방광용량불족정상1／2，핍뇨기압교고적4례환인중，뇨실금급수뇨관반류무명현감경；4례응용색립나신후핍뇨기과도활동명현감경。결론뇨동역학검사비뇨계초성화배설성방광뇨도조영시평개신경성방광적중요수단，신경성방광환인요근거기평개결과채취개성화적치료방안。
Objetive To evaluate the treatment and results of different children with neurogenic blad-der.Methods 15 children with neurogenic bladder were treated between 4,2013 to 1,2014.There were 7 boys and 8 girls who were from 1 year old to 13 years old.All of them were received operation because of my-elomeningocele ever before.Urodynamic,ultrasonography and voiding cystourethrography (VCUG)were fin-ished.Detrusor pressure increased in 8 children.Bladder volume decreased in 12 children.Detrusor overactiv-ity developed in 7 children.Ultrasonography and VCUG indicated hydronephrosis and enlarged ureters in 8 children.7 children developed vesicoureteral reflux.5 children received operations,including enterocystoplasty and ureter reimplantation (Cohen technique)1 patient,enterocystoplasty in 1 patient,reimplantation (Cohen technique)in 1 patient,bladder autoaugmentation and ureter reimplantation (Lich Gregior technique)in 2 pa-tients.10 patients were performed clean intermittent catheterization (CIC),and solifenacin was used in 4 pa-tients.Results Bladder volume increased,detrusor pressure decreased and vesicoureteral reflux disappeared in 2 patients who were performed enterocystoplasty.Bladder volume increased and detrusor pressure decreased a little in 2 patients who were performed bladder autoaugmentation and ureter reimplantation,but vesicoureteral reflux did not disappear.Vesicoureteral reflux disappeared in 1 patient who was performed ureter transplanta-tion.For 6 patients whose bladder volume was larger than two third of expected bladder volume and low detru-sor pressure,urinary incontinence disappeared in 2 patients,ameliorated in 2 patients,had no change in 2 pa-tients after CIC was performed.For 4 patients whose bladder volume was smaller than one second of expected bladder volume and high detrusor pressure,urinary incontinence had no change after CIC was performed.De-trusor overactivity ameliorated in 4 patients who used solifenacin. Conclusions Urodynamic,ultrasonography and VCUG are very important methods to evaluate neurogenic bladder.Different patients should be used differ-ent methods according to the clinical evaluation.