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背景:神经原性尿失禁手术治疗方法多样,疗效不一,探讨手术治疗神经原性尿失禁的效果,以求证其有效性。目的:评价去粘膜回肠浆肌层补片膀胱扩大术治疗反射亢进型神经原性尿失禁疗效,为改良手术提出建议。设计:以患者为研究对象的回顾性病例分析。单位:一所大学医院的小儿外科。对象:对郑州大学第一附属医院小儿外科自1998-04/2004-01手术治疗的68例神经原性尿失禁患者进行随访,所有患者术前均确诊为神经原性尿失禁,随访资料完整者共38例。方法:对38例反射亢进型神经原性膀胱患者随访4～69个月,平均17.2个月。患者年龄4～17岁,38例患者行去粘膜回肠浆肌层补片膀胱扩大术,34例盆底肌松弛者同时行双侧髂腰肌盆底加强术。主要观察指标:观察手术前后症状、膀胱顺应性、最大膀胱容量和相对安全膀胱容量。结果:30例(79%)尿失禁症状改善(控尿时间>1h);尿动力学检查示:所有行回肠去浆肌层膀胱扩大术患者术后均为腹压排尿,尿流动力学检查均未发现在排尿期有主动的逼尿肌收缩;术后顺应性增加(27.43±24.78)mL/kPa(P<0.01),最大膀胱容量较术前增加(122.18±79.99)mL(P<0.01),相对安全膀胱容量较术前增加(98.63±86.78)mL(P<0.01)。未发现有上尿路功能受损加重情况。结论:去粘膜回肠浆肌层补片膀胱扩大术可保护上尿路?
BACKGROUND: Neurogenic urinary incontinence surgery is diversified and has different curative effects. To explore the effect of surgical treatment of neurogenic urinary incontinence in order to verify its effectiveness. Objective: To evaluate the curative effect of mucosa of the mucosa of the mucosa of the mucosa with ipsilateral bladder for the treatment of refractory hyperuricemic neurogenic incontinence. Design: A retrospective case analysis of patients. Unit: A pediatric surgery in a university hospital. PARTICIPANTS: A total of 68 patients with neurogenic urinary incontinence who underwent surgery in the First Affiliated Hospital of Zhengzhou University from January 1998 to January 2004 were followed up. All patients were diagnosed as neurogenic urinary incontinence preoperatively, with complete follow-up data A total of 38 cases. Methods: 38 patients with hyperreflexic neurogenic bladder were followed up for 4 to 69 months (average 17.2 months). Patients aged 4 to 17 years old, 38 patients underwent mucosal ileum to the muscle patch of bladder enlargement, 34 cases of pelvic floor muscle relaxation at the same time bilateral iliopsoas pelvic floor strengthening. MAIN OUTCOME MEASURES: Preoperative and postoperative symptoms, bladder compliance, maximum bladder capacity and relatively safe bladder capacity were observed. Results: The symptoms of urinary incontinence were improved in 30 cases (control of urinary incontinence> 1h). Urodynamic examination showed that all patients with ileal muscular bladder enlargement underwent abdominal pressure and urodynamics No active detrusor contractions during urination were found; postoperative compliance increased (27.43 ± 24.78) mL / kPa (P <0.01) and maximum bladder capacity increased (122.18 ± 79.99) mL (P <0.01) , And the relative safety of bladder volume increased (98.63 ± 86.78) mL compared with preoperative (P <0.01). No increase in upper urinary tract damage was found. Conclusion: Go to mucosa ileum myofascial patch bladder enlargement can protect the upper urinary tract?