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目的探讨神经性膀胱患儿输尿管反流的治疗措施。方法脊膜修补术后神经性膀胱并输尿管反流患儿45例,男29例,女16例,年龄4～14岁。排泄性膀胱尿道造影(VCUG)示膀胱输尿管反流左侧19例,右侧11例．双侧15例,其中Ⅰ°-Ⅲ°12例(15条),Ⅲ°-Ⅴ°33例(45条)。Ⅰ°-Ⅱ°中,5例(7条)仅行清洁间歇导尿,7例(8条)行保留膀胱黏膜肠浆肌层膀胱扩大术；Ⅲ°-Ⅴ°中,9例(12条)仅行间歇导尿。24例(33条)行保留膀胱黏膜肠浆肌层膀胱扩大术,其中19例(28条)同时行Lich-Gregoir手术,术后配合间歇导尿。结果6个月后随访,Ⅰ°-Ⅱ°15条中,7条行清洁间歇导尿,3条反流消失(42．9%),8条行保留膀胱黏膜肠浆肌层膀胱扩大术者,6条反流减轻或消失(75．0%)；Ⅲ°-Ⅴ°45条中,12条行间歇导尿者,10条反流程度进一步加重,5条单纯行膀胱扩大术者,2条反流减轻或消失(40．0%),28条同时行Lich-Gregoir手术者,23条反流减轻或消失(82．1%)。结论神经性膀胱输尿管反流的治疗方法取决于输尿管反流的程度。Ⅰ°-Ⅱ°单纯行膀胱扩大术,也可考虑只行清洁间歇导尿；Ⅲ°-Ⅴ°反流须在行膀胱扩大术的同时行输尿管抗反流术,术后配合间歇导尿。
Objective To investigate the treatment of ureteral reflux in children with neurogenic bladder. Methods 45 cases of neurogenic bladder and ureteral reflux after spinal meningomyxerectomy, 29 males and 16 females, aged 4 to 14 years old. Excretory vesicourethral angiography (VCUG) showed bladder ureter reflux in the left side of 19 cases, right in 11 cases. Bilateral in 15 cases, of which Ⅰ ° -Ⅲ ° 12 cases (15), Ⅲ ° -V ° 33 cases (45). In the Ⅰ ° -Ⅱ ° group, intermittent catheterization was performed in only 5 cases (7 cases), while bladder mucosa was preserved in 7 cases (8 cases). In Ⅲ ° -Ⅴ °, 9 cases (12 cases Only intermittent catheterization. Twenty-four cases (33 cases) retained bladder mucosa of bladder mucosa, including 19 cases (28 cases) underwent Lich-Gregoir operation at the same time with intermittent catheterization. Results Six months later, intermittent catheterization was performed in 7 of 15 cases of Ⅰ ° -Ⅱ °, 42 cases of reflux disappeared in 3 cases (42.9%), 8 cases of bladder mucosa preserved in bladder mucosa , Six regurgitant reduce or disappear (75.0%); Ⅲ ° -V ° 45, 12 intermittent catheterization, 10 further aggravate the degree of reflux, 5 simple bladder enlargement, 2 The reflux was relieved or disappeared (40.0%). Among the 28 patients who underwent Lich-Gregoir operation at the same time, 23 patients had a decrease or disappearance of reflux (82.1%). Conclusion The treatment of neurogenic vesicoureteral reflux depends on the degree of ureteral reflux. Ⅰ °-Ⅱ ° simple line of bladder expansion surgery can also be considered only intermittent catheterization; Ⅲ ° -V ° reflux should be underwent bladder augmentation ureter anti-reflux surgery, with intermittent catheterization.