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目的探讨构建“体神经-内脏神经”反射弧治疗脊柱裂脊髓脊膜膨出患者大小便功能障碍的疗效。方法对4例脊髓脊膜膨出大小便功能障碍患者,行左侧L5前根近端与S3前根远端吻合,术前与术后8￣18个月行尿流动力学比较。结果4例均获得1年以上随访。3例高反射型患者于术后10￣12个月恢复可控性排尿,充盈性尿失禁消失,剩余尿逐渐减至(18±13)mL;1例无反射型患者于术后8个月获得控尿和自主排尿功能,尿失禁消失,排尿间期逐渐延长至2￣3h,逼尿肌压由1.29kPa增加至2.98kPa。4例患者在获得膀胱可控功能的同时,直肠肛门括约肌功能也转为基本正常,下肢功能损伤较小。结论建立人工体神经-内脏神经反射弧能有效地修复脊髓脊膜膨出所致的膀胱直肠功能障碍。
Objective To investigate the curative effect of constructing “body-nerve-visceral nerve” reflex arc for defecation and dysfunction in patients with spina bifida myelomeningocele. Methods In 4 patients with mesencephalic dysfunction due to spinal meningocele, the proximal end of L5 anterior root and distal root of S3 were anastomosed. The urodynamics were compared before and 8-18 months after operation. Results 4 cases were obtained more than 1 year follow-up. Three patients with hyperreflexia returned to controllable micturition 10 to 12 months after operation. Fetal urinary incontinence disappeared and the residual urine gradually decreased to (18 ± 13) mL. One patient with no reflex was at 8 months Obtained urine control and autonomic urinary function, urinary incontinence disappeared, urinary interval gradually extended to 2 ~ 3h, detrusor pressure increased from 1.29kPa to 2.98kPa. 4 patients with bladder controllable function at the same time, rectal anal sphincter function is also converted to normal, lower functional impairment less. Conclusion Establishing artificial body nerve - visceral nerve reflex arc can effectively repair bladder rectum dysfunction caused by spinal meningocele.