【作者】 齐林；

【导师】 文建国；

【作者基本信息】 郑州大学 ， 小儿膀胱功能障碍诊断和治疗， 2005， 硕士

【摘要】 背景和目的 研究背景 脊髓脊膜膨出是小儿最常见的一种先天性神经系统发育畸形。本病的发生率为1/1000～5000,各地区、种族之间有一定差异。北爱尔兰发病率高达4.2‰,而国内资料报导平均发病率为1/3000。亚洲地区发病率为0.18～1.06‰,男婴与女婴发病率之比为3:2。1959年北京的产科医院曾统计本病在初生婴儿中发病率为1:1000～1:5000,一般认为仅比先天性直肠肛门畸形的发病率略低。脊髓脊膜膨出是胚胎时期神经管闭合过程发生障碍,引起脊柱椎管闭合不全,使得脊髓、脊膜等椎管内组织经过椎弓不正常裂孔疝出皮下,并突出形成一球形囊性肿物。这些畸形可导致肢体瘫痪,大小便功能障碍,脑积水等。其中,大小便功能障碍的手术治疗比较棘手,是临床医生所面临的难题。如何选择恰当的术式,降低手术负损伤,提高疗效,是临床医生的目标。 脊髓栓系综合征是指当脊髓受到某种病理因素的纵向牵拉,其末端回缩不良,而引起的神经损害症候群,它包括一系列的病理生理异常,常有脊髓低位（低于L₁～2间隙）和终丝紧张变粗,出现下肢及会阴部感觉异常、引起不同程度的肢体瘫痪和大小便功能障碍等。由于脊髓脊膜膨出系先天性神经管发育畸更多还原

【Abstract】 Background and ObjectiveMeningomyelocele is the most common inborn nervous system developmental malformation in children. Meningomyelocele’s incidence rate is 1/1000 ~ 5000,difference in every region and stock .North- Irish is high to 4.2‰, average incidence rate is 1/3000 in china , Asia is 0.18~1.06‰. It has been reported that average incidence rate is 1: 1000~1: 5000 in newborn in Beijing’s Obstetrics hospital 1959. Meningomyelocele may cause limbs paralysis, urination and defecation dysfunction, hydrocephalus, dementia and so on. Urination and defecation dysfunction is very difficult to management in clinical practice. How to select appropriate operation for decrease negatively damage and improve the curative effect is still the clinician’s goal.Meningomyelocele usually associate with tethered cord syndrome(TCS), which is very harmful to infant. So more and more pediatrician pay attention to it. "Free sacro- capsule" operation is a new operation to treat TCS due to meningomyelocele.However, the treatment results has not got popular accepted due to lack of objectively evaluation methods. In present study, with urodynamic advance, we can using urodynamic’s methord to evaluate "free sacro- capsule" pre- operation and post-operation effect, also evaluate bladder and urethral function providing objective date to support using "free sacro- capsule" operation to treat TCS due to meningomyelocele.The urodynamic records of 20 children with meningomyelocele and TCS were reviewed from 2002 to 2004. Meningomyelocele and TCS children were divided into two groups, one is pre-operation ,the other is post-operation .The differences of urodynamic parameters were compared between two groups.Material and Methods1. Patients Twenty children with Meningomyelocele and TCS were included in this study, who are 2 months ~6 years ,13 boys and 7 girls .2. Methods In this research free uroflowmetry 、 filling cystometry 、 pressure-flow- electromyography、 urethral pressure measurement were performed in all patients according to the recommendations of the International Children Continence Society (ICCS). Urodynamic parameters inducing maximum cystometric capacity(MCC) 、 detrusor leak point pressure (DLPP)、 neurogenic detrusor overactivity (NDOA)、 detrusor-sphinctor dyssynergia (DSD)、 bladder compliance (BC) 、 max free flow rate(MFR)、 post void residual(PVR)、 max urethral closure pressure (MCP) and static urethral functional length (SFL) were measured and calculated in all cases. The function of detrusor in voiding was classified as hypercontractile detruor (HD)、 normal detrusor (ND)、 detrusor underactivity (DUA) and acontractile detrusor (ACD) according to ICCS. Andall children check X-ray and MRI before operation.Statistical analysisStatistical analyses were carried out using the Statistical Package for Social Sciences (SPSS), version 10.0 for windows. Paired t test and chi-square test was used. P-values of <0.05 were considered to be statistically significant.Results1 All children have none damage after operation. Seven children whose operation cut healing is well; Two children who with leakage of cerebrospinal fluid, recovered after pressure dressing. One child who has urination and defecation dysfunction has healed. Three children who have both lower extremities underactivity improved significantly at two weeks later after operation.2 The PVR and DLPP of post-operation group was significantly decreased than that of pre-operation group (P<0.05) .3 The BC and MCC of post-operation group was significantly higher than pre-operation group (P<0.05)4 There are no significant difference in MCP、 SFL、 DSD、 NDOA、 ACD among the pre-opration group and the post-opration group, (p>0.05) .Conclusion1 Management meningomyelocele and TCS using "free sacro- capsule" operation is safe and effective, all children have no damage after operation.2 The BC and MCC of post-operation group was significantly higher than pre-operation group (P<0.05), confirmed this operation can improve serious urinary system symptom.3 The PVR and DLPP of post-operation group was significantly smaller than pre-operation group (P<0.05) , confirmed this operation can decrease upper urinary tract damage development.4 There are no significant difference in MCP、 SFL、 DSD、 NDOA、 ACD among the pre-opration group and the post-opration group (P>0.05 ) .更多还原