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目的探讨膀胱自扩大手术治疗高反射性神经原性膀胱的方法及疗效。方法6例患者,男5例,女1例,年龄5～36岁,平均28岁。尿动力学检查显示6例均为膀胱反射亢进,逼尿肌括约肌协同失调。病程5～10年,平均6年。对6例患者的手术方法,手术前后膀胱容量,肾功能以及临床症状进行回顾分析。结果手术时间100～180min,平均120min。安全膀胱容量术前(182±52)ml,术后3个月(315±65)ml,术后10个月(420±105)ml,手术前后比较差异有统计学意义(P<0.01)。术后导尿间歇平均4h(3～5h),术前5例尿失禁患者尿失禁消失4例,1例经口服抗胆碱药物后症状明显改善。术前4例肾功能异常者3例恢复正常,1例改善。结论膀胱自扩大术结合清洁间歇自家导尿治疗高反射性小容量膀胱是一种简便,可靠的方法。
Objective To investigate the method and curative effect of bladder self-expanding surgery on highly reflex neurogenic bladder. Methods Six patients, 5 males and 1 females, aged 5 to 36 years old with an average of 28 years old. Urodynamic examination showed that 6 cases were bladder hyperreflexia, detrusor sphincter coordination disorders. Course of 5 to 10 years, an average of 6 years. Six cases of surgical methods, bladder volume before and after surgery, renal function and clinical symptoms were retrospectively analyzed. Results The operation time was 100 ~ 180min with an average of 120min. The safe bladder volume was (182 ± 52) ml before surgery, 315 ± 65 after 3 months and 420 ± 105 after 10 months. The difference was statistically significant before and after operation (P <0.01). Postoperative urinary intermittent averaging 4h (3 ~ 5h), urinary incontinence disappeared in 5 cases of preoperative urinary incontinence in 4 cases, 1 case of oral anticholinergic drugs significantly improved symptoms. Three cases of abnormal renal function before surgery returned to normal and one case improved. Conclusion Bladder self-expansion combined with clean intermittent self-catheterization is a simple and reliable method for the treatment of high-reflectivity small volume bladder.