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目的:介绍一种诊断儿童膀胱出口梗阻(BOO)的方法。方法:对31例下尿路功能障碍儿童进行排尿期压力-流率测定。采用耻骨上膀胱穿刺置管法测定膀胱压力,同步测定直肠压、尿流率及外括约肌肌电图(EMG);按 A-G 列线图及 P-Q 图诊断 BOO,应用直线 PURR 及 Schifer列线图将 BOO 分为7度;应用压力-流率-EMG 测定将逼尿肌-尿道外括约肌协同失调(DESD)分为Ⅰ型(起始型)、Ⅱ型(间断型)、Ⅲ型(持续型)。结果:31例患儿中器质性 BOO 为22例,其中Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ度梗阻分别为2、5、3、9、3例,5例尿道瓣膜患儿术后4例梗阻程度减轻,1例无明显减轻;9例功能性 BOO 中Ⅰ、Ⅱ、Ⅲ型 DESD 各为1、5、3例。结论:此法测定结果准确,对于儿童 BOO 的诊断与鉴别诊断、疗效评价及疗效不佳的原因分析等具有重要意义。
Objective: To introduce a method to diagnose bladder outlet obstruction (BOO) in children. Methods: Thirty-one children with dysfunction of lower urinary tract were tested for urinary pressure-flow rate. Bladder pressure was measured by suprapubic bladder puncture catheterization, and the rectal pressure, urinary flow rate and external sphincter electromyography (EMG) were measured simultaneously. BOO was diagnosed by AG collinear chart and PQ chart. The linear PURR and Schifer nomogram BOO was divided into seven degrees; the detrusor - external urethral sphincter dysfunction (DESD) was divided into type Ⅰ (initial), type Ⅱ (discontinuous), type Ⅲ . Results: There were 22 cases of organic BOO in 31 cases, of which, 2, 3, 3, Ⅳ, Ⅴ and Ⅵ degrees were 2, 5, 3, 9 and 3, respectively. The degree of obstruction reduced in one case without significant reduction; 9 cases of functional BOO Ⅰ, Ⅱ, Ⅲ DESD each of 1,5,3 cases. Conclusion: The accuracy of this method is of great significance for diagnosis and differential diagnosis of children with BOO, efficacy evaluation and analysis of causes of poor efficacy.