建立人工膀胱反射弧治疗脊髓损伤后神经原性膀胱的临床研究

Reestablishment of artificial bladder reflex arc for the treatment of neurogenic bladder after spinal cord injury, a clinical study

中文关键词:  脊髓损伤  神经原性膀胱  排尿  反射弧  尿动力学检查

英文关键词:Spinal cord injury  Neurogenic bladder  Micturition  Reflex arc  Urodynamic study

中文摘要:

  【摘要】目的：观察利用脊髓正常反射通路重建人工膀胱反射弧恢复脊髓损伤后神经原性膀胱功能的临床疗效。方法：对36例完全性脊髓损伤（ASIA分级A级）患者行人工膀胱反射弧重建，其中28例脊髓圆锥上脊髓损伤患者（痉挛性膀胱），切断并显微吻合单侧S1前根与支配膀胱最强的神经根（一般为S2或S3）前根；8例脊髓圆锥损伤患者（弛缓性膀胱）采用腓肠神经移植并显微吻合T10/T11神经根前根及支配膀胱最强的神经根前根。通过对34例（2例痉挛性膀胱患者死亡）患者术前、术后6、12、18个月随访并行尿流动力学检查（无菌生理盐水灌注速度25ml/s），评估痉挛性和弛缓性膀胱功能恢复情况。两种不同类型的神经原性膀胱患者均选其具有代表意义的尿流动力学检查指标，整理数据后进行统计学分析。结果：26例痉挛性膀胱患者，最大膀胱测压容积术后3个时间点间比较差异无显著性（P＞0.05），但与术前比较均有显著性差异（P＜0.05）；残尿量、膀胱顺应性不同时间点间比较两两均有显著性差异（P＜0.05）。8例弛缓性膀胱患者，最大膀胱测压容积术后与术前比较差异无显著性（P＞0.05）；残尿量由术前的495.1±56.6ml降至术后18个月时的264.4±30.8ml，且术后不同时间点与术前比较均有统计学意义（P＜0.05）；最大逼尿肌压力由术前的6.3±3.9cmH2O升高到术后18个月时的82.9±4.3cmH2O，且术后3个时间点与术前比较差异均有显著性（P＜0.05）。未发现一例通过搔抓下腹部皮肤引起排尿。结论：利用脊髓正常反射通路重建神经原性膀胱人工反射弧改善膀胱功能是可行而有效的方法。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical outcomes of re-establishment of the artificial bladder reflex arc with the normal reflex pathway to restore functions of neurogenic bladder after spinal cord injury. Methods: Reconstruction of the artificial reflex arc was performed on 36 patients with complete spinal cord injury(ASIA: A), including 28 patients(spastic bladder) with spinal cord injury above the conus medullaris undergoing unilateral microanastomosis of S1 anterior roots to main bladder innervating roots(S2 or S3) and 8 patients(atonic bladder) with conus medullaris injury undergoing unilateral microanastomosis of the T10/T11 ventral root to main bladder innervating ventral root with sural nerve. Micturition function of 34 patients(2 patients with spastic bladder died) were followed up and examined by urodynamic examination (rate of flooding of NS was 25ml/s) postoperatively at the 6th, 12th, 18th month respectively to evaluate the function recovery of spastic bladder and flaccid bladder. Two different types of neurogenic bladder patients were selected asrepresentative of urodynamics index, statistic analysis of data. Results: 26 spastic bladder patients were included in this series. Three times of sample collection of subjects′ maximum cystometric capacity were conducted at pre- and post-operation respectively. No significant difference(P>0.05) was noted among 3 postoperative time point results; however significant difference was noted when compared with the pre-operative result(P<0.05). The index of volume of residual and bladder compliance presented significant difference between 2 groups respectively(P<0.05). While for 8 atonic bladder patients with the same method, there was no significant difference(P>0.05) mutually on maximum cystometric capacity as the pre- and post-operation respectively. Volume of residual decrease from the pre-operation value 495.1±56.6ml to the post-operation value 264.4±30.8ml, it showed a significant difference with the pre-operative patients themselves(P<0.05). Pdet.max went up to the post-operation value 82.9±4.3cmH2O from the pre-operation value 6.3±3.9cmH2O, there was a significant difference with the pre-operative(P<0.05). There was no case micturates caused by scratching abdomen skin in the two case studies. Conclusions: Using the normal reflex pathway to reconstruct artificial reflex arc for treating bladder functions is feasible.