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目的探讨早期评价和干预治疗对脊髓发育不良所致的神经原性膀胱患儿上尿路和膀胱功能的影响。方法回顾性分析1997～2003年收治的脊髓发育不良,尿流动力学显示存在膀胱高压和/或逼尿肌括约肌不协调的75例年龄在1岁以内神经原性膀胱患儿,其中30例从发现高危因素后即开始应用间歇导尿和抗胆碱能药物治疗的患儿作为研究组,随访数年,记录上尿路功能、膀胱功能及手术干预情况,与其余没有进行间歇导尿和抗胆碱能药物治疗的患儿(对照组)进行比较。结果平均随访时间6.6年(3.6～9.8年),研究组共30例患儿,在随访期间2例出现上尿路持续性扩张,2例膀胱输尿管反流,3例膀胱顺应性差,最终5例行膀胱扩大术;对照组除去7例失访,38例中18例上尿路扩张,15例膀胱输尿管反流,23例膀胱顺应性下降,26例行膀胱扩大术,上尿路损害和最终需行膀胱扩大术的病例研究组明显低于对照组。结论脊髓发育不良所致的神经原性膀胱,病理损害是逐渐加重的,如早期进行尿流动力学评价,针对高危因素早期预防性治疗对保护肾脏和膀胱功能,控制尿失禁,减少膀胱扩大术,被证实是有效的。
Objective To investigate the effects of early evaluation and intervention on the urinary tract and bladder function in children with neurogenic bladder caused by poor development of spinal cord. Methods A retrospective analysis of 75 patients with neurogenic bladder within 1 year of age with spinal cord dysplasia admitted to 1997 to 2003 and urodynamic studies showing bladder incompatibility and / or detrusor sphincter was uncoordinated. Of these, 30 Children with intermittent catheterization and anticholinergic treatment started to be the study group after high-risk factors. After a few years of follow-up, upper urinary tract function, bladder function and surgical intervention were recorded. The remaining patients without intermittent catheterization and anti- Alkaline medication-treated children (control group) were compared. Results The average follow-up time was 6.6 years (3.6-9.8 years). A total of 30 children in the study group were followed up for 2 cases of persistent upper urinary tract expansion, 2 cases of vesicoureteral reflux, 3 cases of poor bladder compliance and finally 5 cases In the control group, 7 cases were lost to follow-up, 18 cases of upper urinary tract dilatation in 38 cases, 15 cases of bladder ureter reflux, 23 cases of decreased bladder compliance, 26 cases of bladder enlargement, upper urinary tract injury and finally Case study group required bladder augmentation was significantly lower than the control group. Conclusion Neurogenic bladder caused by dysplasia of the spinal cord is gradually aggravated. For example, early urodynamic evaluation, early prophylaxis of high risk factors for the protection of renal and bladder function, control of urinary incontinence, reduction of bladder augmentation, It proved to be effective.