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目的探讨回肠浆肌层膀胱扩大术治疗神经源性膀胱患儿的远期疗效。方法应用回肠浆肌层膀胱扩大术治疗神经源性膀胱患儿32例。男23例,女9例;8例术前合并双肾输尿管积水及双侧输尿管扩张,3例单侧膀胱输尿管返流,2例有轻度肾功能损害。对比手术前后主观症状[国际尿失禁咨询委员会问卷简表(ICI-Q-SF问卷)]、尿流动力学检查、泌尿系超声及逆行膀胱造影,评价术后疗效。术后所有患儿定期复查血电解质、肾功能及泌尿系超声,监测并发症。结果随访5～12a,26例(81.25%)临床症状好转或痊愈,6例(18.75%)无明显改善。术前ICI-Q-SF问卷评分为(18.1±1.0)分,随访结束为(7.8±2.5)分,二者比较差异有统计学意义(t=14.688,P=0.000)。尿流动力学检查显示术后最大膀胱容量、膀胱顺应性较术前明显增加,充盈末逼尿肌压较术前降低。术后电解质、肾功能均正常。远期并发症5例:4例并症状性泌尿系感染,1例并膀胱结石。结论回肠浆肌层膀胱扩大术治疗神经源性膀胱患儿并发症少,远期疗效比较理想。
Objective To investigate the long-term efficacy of ileal myometrial bladder expansion in children with neurogenic bladder. Methods 32 cases of neurogenic bladder were treated with ileal myometrial bladder augmentation. There were 23 males and 9 females. Eight patients had bilateral preoperative ureteral hydronephrosis and bilateral ureteral dilatation, 3 had unilateral vesicoureteral reflux, and 2 had mild renal impairment. Comparisons of subjective symptoms before and after surgery [ICI-Q-SF Questionnaire], urodynamics, urologic ultrasound and retrograde cystography were performed to evaluate postoperative efficacy. All children were regularly reviewed blood electrolytes, renal function and urinary ultrasound, monitoring of complications. Results All the patients were followed up for 5 ~ 12 years. 26 cases (81.25%) had clinical symptoms recovered or recovered, and 6 cases (18.75%) showed no significant improvement. The preoperative score of ICI-Q-SF questionnaire was (18.1 ± 1.0) points and the end of follow-up was (7.8 ± 2.5) points, the difference was statistically significant (t = 14.688, P = 0.000). Urodynamic examination showed that the maximum bladder capacity and bladder compliance were significantly increased after operation, and the urinary pressure at the end of filling was lower than that before operation. Electrolytes, renal function are normal. Long-term complications in 5 cases: 4 cases and symptoms of urinary tract infection, 1 case of bladder stones. Conclusion Ileal myoflagella augmentation in children with neurogenic bladder less complications, long-term efficacy is ideal.