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采用可控性肠膀胱扩大术治疗晚期神经原性膀胱,改善排尿失控、上尿路高压造成的肾积水或尿毒症,比单纯膀胱造瘘管理方便,效果良好。 1 临床资料 1989年4月～1993年10月共治疗神经原性膀胱合并重度肾积水或尿毒症7例,男5例,女2例,年龄21～59岁。病因包括脊膜膨出术后2例,脊椎裂2例,椎管狭窄椎板减压术后脊髓退行性变1例,脊髓损伤2例。病人均未经过合理治疗,出现肾积水或尿毒症后才来就诊。术前主要症状是排尿失控、湿裤尿床、厌食、恶心、呕吐,血尿素氮9.46mmol/L1例,2.50mmol/L以上6例,残余尿量120～230ml,膀胱造影表现边缘锯齿状小膀胱4例,造影剂输尿管肾盂反流3例共5条输尿管,膀胱测压表现逼尿肌反射亢进型膀胱。B超检查均显示中、重度肾积水,术前均保留尿管持续引流,待尿素氮基本恢复正常后再进行手术。 2 手术方法
The use of controllable bowel expansion in the treatment of advanced neurogenic bladder, improve urination uncontrollability, hydronephrosis caused by upper urinary tract or uremia than simple bladder fistula management, with good results. 1 Clinical data April 1989 ~ October 1993 were treated neurogenic bladder combined with severe hydronephrosis or uremia in 7 cases, 5 males and 2 females, aged 21 to 59 years. Etiology included 2 cases of spinal meningocele, 2 cases of spina bifida, 1 case of spinal degenerative spinal cord decompression after spinal stenosis, and 2 cases of spinal cord injury. Patients have not been properly treated, hydronephrosis or uremia came after treatment. The main symptoms of preoperative loss of urine control, wet pants wetting bed, anorexia, nausea and vomiting, blood urea nitrogen 9.46mmol / L1 cases, 2.50mmol / L more than 6 cases, residual urine output 120 ~ 230ml, cystography showed marginal jagged bladder 4 cases, 3 cases of contrast-induced ureteropelvic pyelic ureter, ureter, bladder manifestations of bladder detrusor hyperreflexia. B-ultrasound showed moderate and severe hydronephrosis, preoperative retention of the catheter continued drainage until urea nitrogen returned to normal before surgery. 2 surgical methods