【摘要】 目的探讨神经性膀胱患儿输尿管反流的治疗措施。方法脊膜修补术后神经性膀胱并输尿管反流患儿45例,男29例,女16例,年龄4～14岁。排泄性膀胱尿道造影(VCUG)示膀胱输尿管反流左侧19例,右侧11例．双侧15例,其中Ⅰ°-Ⅲ°12例(15条),Ⅲ°-Ⅴ°33例(45条)。Ⅰ°-Ⅱ°中,5例(7条)仅行清洁间歇导尿,7例(8条)行保留膀胱黏膜肠浆肌层膀胱扩大术；Ⅲ°-Ⅴ°中,9例(12条)仅行间歇导尿。24例(33条)行保留膀胱黏膜肠浆肌层膀胱扩大术,其中19例(28条)同时行Lich-Gregoir手术,术后配合间歇导尿。结果6个月后随访,Ⅰ°-Ⅱ°15条中,7条行清洁间歇导尿,3条反流消失(42．9%),8条行保留膀胱黏膜肠浆肌层膀胱扩大术者,6条反流减轻或消失(75．0%)；Ⅲ°-Ⅴ°45条中,12条行间歇导尿者,10条反流程度进一步加重,5条单纯行膀胱扩大术者,2条反流减轻或消失(40．0%),28条同时行Lich-Gregoir手术者,23条反流减轻或消失(82．1%)。结论神经性膀胱输尿管反流的治疗方法取决于输尿管反流的程度。Ⅰ°-Ⅱ°单纯行膀胱扩大术,也可考虑只行清洁间歇导尿；Ⅲ°-Ⅴ°反流须在行膀胱扩大术的同时行输尿管抗反流术,术后配合间歇导尿。更多还原

【Abstract】 Objective To review the management of vesico-ureteral reflux(VUR) secondary to neurogenic bladder.Methods 45 cases of neurogenic bladder with VUR after spinal meningocele re- pairs were retrospectively analyzed.There were 29 boys and 16 girls with age ranging from 4 to 14 years.Voiding cystourethrography(VCUG)showed 19 cases with left side reflux,11 right side with right side reflux,and 15 with bilateral reflux.There were 12 cases(15 sides)ofⅠ°-Ⅱ°reflux and 33 cases(45 sides)of gradeⅢ°-Ⅴ°reflux.Of 15 ureters with gradeⅠ°-Ⅱ°reflux,7 were managed by clean intermittent catheterization(CIC)and 8 with augmentation cystoplasty.Augmentation cys- toplasty were carried out in 33 patients with gradeⅢ°-Ⅴ°reflux,in which 28 underwent Lich-Gregoir operation simultaneously.12 ureters with gradeⅢ°-Ⅴ°reflux were managed with CIC alone.All of the patients were followed up for 6 months.Results With gradeⅠ°-Ⅱ°reflux,the reflux in 3 out of 7 ure- ters disappeared with CIC alone(42.9%)and 6 out of 8 ureters disappeared or reduced after augmen- tation cystoplasty(75%).Of 45 ureters with gradeⅢ°-Ⅴ°reflux,2 of 5 ureters disappeared after augmentation cystoplasty alone(40%)and 23 of 28 ureters disappeared or reduced after augmentation cystoplasty with Lieh-Gregoir operation(82%).10 of 12 ureters without operation deteriorated.Con- clusions The management of VUR secondary to neurogenie bladder depends on the extent of VUR.Ⅰ°-Ⅱ°reflux can be treated by augmentation cystoplasty.Good results can also be achieved with CIC a- lone.Ⅲ°-Ⅴ°reflux needs augmentation cystoplasty with Lich-Gregoir operation.CIC should be star- ted post-operatively.更多还原