论文部分内容阅读
目的 探讨脊髓栓系综合征 (TCS)患儿术后尿动力学表现及其临床意义。 方法 对4 0例TCS患儿术后行尿动力学测定 ,分析影响术后下尿路症状改善及尿动力学结果的因素。 结果 4 0例患儿中 5例手术前后均无下尿路症状 ,术前 35例有尿失禁伴夜间遗尿者中术后 8例尿失禁减轻 ,2 4例无变化 ,3例加重。尿动力学测定示膀胱顺应性降低 2 1例 ,剩余尿增加 2 1例 ,逼尿肌无力19例 ,膀胱容量减小 15例 ,逼尿肌反射亢进 13例 ,逼尿肌括约肌协同失调 8例 ,漏尿点压力 >4 0cmH2 O (1cmH2 O =0 .0 98kPa) 4例。自述无下尿路症状 5例中 ,膀胱逼尿肌反射亢进 2例 ,逼尿肌括约肌协同失调 2例 ,基本正常 1例。术后尿失禁改善率原发性TCS(2 8.6 % ,8/ 2 8)高于继发性(0 % ,0 / 7,P =0 .0 4 8) ,非脂肪瘤型 (10 0 % ,3/ 3)高于脂肪瘤型者 (15 .6 % ,5 / 32 ,P =0 .0 0 4 ) ,脊膜膨出型 (36 .4 % ,8/ 2 2 )高于脊髓脊膜膨出型 (0 % ,0 / 6 ,P =0 .0 4 7) ,出生时无泌尿系症状者 (80 % ,4 / 5 )高于出生时有泌尿系症状者 (17.4 % ,4 / 2 3,P =0 .0 19)。尿动力学测定示术后原发性TCS逼尿肌反射亢进的发生率 (2 4 .2 % ,8/ 33)低于继发性TCS(71.4 % ,5 / 7,P =0 .0 15 ) ,非脂肪瘤型 (12 .5 % ,1/ 8)低于脂肪瘤型TCS(5 6 .3%
Objective To investigate the postoperative urodynamic findings and its clinical significance in children with tethered cord syndrome (TCS). Methods The urodynamics of 40 children with TCS after operation were analyzed, and the factors influencing the improvement of urinary tract symptoms and urodynamic results were analyzed. Results Among the 40 cases, 5 cases had no symptoms of lower urinary tract before and after operation. Among the 35 cases with incontinence and nocturnal enuresis, 8 cases had postoperative urinary incontinence reduction, 24 cases had no change and 3 cases had aggravation. Urodynamic analysis showed 21 cases of decreased bladder compliance, 21 cases of residual urine increase, 19 cases of detrusor weakness, 15 cases of decreased bladder capacity, 13 cases of detrusor hyperreflexia, 8 cases of detrusor sphincter imbalance , Leak urine pressure> 4 0cmH2O (1cmH2O = 0. 98kPa) in 4 cases. In 5 cases with no symptoms of lower urinary tract, 2 cases of bladder detrusor hyperreflexia, 2 cases of detrusor sphincter dysfunction, and 1 case of normal deformity. The rate of postoperative urinary incontinence improvement was higher than that of secondary (0%, 0/7, P = 0. 0.048), non-lipoma (10 0% , 3/3) were higher than those with lipoma (15.6%, 5/32, P = 0.040), and spina bifida (36.4%, 8/2 2) (80%, 4/5) were higher than those who had urinary symptoms at birth (17.4%, 4%, 0%, 0/6, P = 0.047) / 2 3, P = 0 .0 19). The urodynamic tests showed that the incidence of postoperative detrusor hyperreflexia of primary TCS was lower (24.2%, 8/33) than that of secondary TCS (71.4%, 5/7, P = .015 ), Non-lipoma type (12.5%, 1/8) lower than liposarcoma type TCS (56.3%