摘要
目的 探讨脊髓拴系综合征患者 (TCS)尿流动力学特征及其临床意义。方法 对 94例患者采用显微松解术于术前 1周及术后 3～ 6个月内行尿流动力学检查。结果 80例 (85 1% )TCS患者存在下尿路症状 ,尿流动力学检查A组 (有下尿道症状组 )均存在神经源性损害 ;B组 (无下尿道症状组 ) 14例中 11例存在神经源性损害。A组和B组膀胱输尿管返流率分别为 43 8%和 14 3 %。α组(无上尿道损害组 )最大尿道闭合压 (MUCP)为 45cmH2 O± 18cmH2 O ,最大膀胱逼尿肌压 (MDP)为 2 7cmH2 O± 15cmH2 O ,明显低于 β组 (有上尿道损害组 )的 6 7cmH2 O± 2 4cmH2 O和 44± 17cmH2 O ,而α组膀胱顺应性 (BC)为 5 6ml/cmH2 O± 0 9ml/cmH2 O ,明显高于 β组的 2 5ml/cmH2 O± 1 2ml/cmH2 O。Ⅰ组 (原发性TCS组 )术后MUCP为 32ml/cmH2 O± 14cmH2 O ,MDP为 2 1ml/cmH2 O± 12cmH2 O ,BC为 9 5ml/cmH2 O± 1 3ml/cmH2 O ,较术前 6 3ml/cmH2 O± 2 5cmH2 O、37ml/cmH2 O± 16cmH2 O和 5 1ml/cmH2 O± 0 8ml/cmH2 O明显改善 ;Ⅱ组 (继发性TCS组 )术后MUCP、MDP和BC较术前无明显变化。结论 尿流动力学检查可明确TCS下尿道症状的神经病学特征 ,能在亚临床期发现膀胱神经源性损害 ,指导治疗。
Objective To evaluate the urodynamic characteristics of children with tethered cord syndrome(TCS) and its clinical significance. Methods We conducted urodynamic studies in 94 cases of TCS who underwent microsurgical release within one week preoperatively and 3 to 6 months postoperatively. Results 80 out of 94 (85 1%)children with TCS presented with lower urinary tract symptoms.Neuropathic injuries were found both in patients in group A(with lower urinary tract symptoms) and in 11 out of 14 patient in group B(without lower urinary tract symptoms).The maximum urethral closing pressure(MUCP) and maximum detrusor pressure (MDP)were significantly lower in groupα(without upper urinary tract injury),which were 45 cm H 2O±18 cm H 2O and 27 cm H 2O±15 cm H 2O respectively,than in groupβ(with upper urinary tract injury),which were 69 cm H 2O±24 cm H 2O and 44 cm H 2O±17 cm H 2O respectively,while bladder compliance (BC)in groupα(5.6 cm H 2O±0.9 ml/cm H 2O)was significantly higher than in group β(2 5 ml/cm H 2O±1 2 ml/cm H 2O).MUCP、MDP and BC were improved in group Ⅰ(primary TCS) after cord untethering, 32 cm H 2O±14 cm H 2O、 21 cm H 2O±12 cm H 2O、9.5 ml/cm H 2O±1.3 ml/cm H 2O postoperatively and 63 cm H 2O±245 cm H 2O、37 cm H 2O±156 cm H 2O、5 1 ml/cm H 2O±0.8 ml/cm H 2O preoperatively respectively,while in group Ⅱremained unchangable. Conclusion Urodynamic studies are effective methods to identify neuropathic characteristics of lower urinary tract symptom in childern with TCS and to find neuropathic injury during subclinical period.According to urodynamic studies,increase of MUCP and DP and decrease of BC are high risk factors of vesicoureteral reflux and upper urinary tract injury.Microsurgical release can improve bladder function in primary TCS,while do no good to bladder function in secondary TCS.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2001年第4期216-218,共3页
National Medical Journal of China
