An artificial somatic-autonomic reflex pathway procedure for bladder control in children with spina bifida
An artificial somatic-autonomic reflex pathway procedure for bladder control in children with spina bifida
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DOI：
10.1097/01.ju.0000158072.31086.af
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发表时间：
2005-06-01
影响因子：
6.6
通讯作者：
Lepor, H
中科院分区：
文献类型：
--
作者：
Xiao, CG;Du, MX;Lepor, H
目的：神经源性膀胱是脊柱裂患儿的主要问题。尽管有严格的药物和手术治疗，失禁，尿路感染和上尿路恶化仍然是问题。我们先前已经证明了在脊髓损伤患者中通过手术建立皮肤-中枢神经系统-膀胱反射通路并恢复膀胱储存和排空的能力。我们报告我们的经验，这个程序在20名儿童脊柱裂。材料和方法：所有儿童脊柱裂和神经源性膀胱进行了有限的椎板切除术和腰腹根（VR）的S3 VR显微吻合。轴突再生后，L5背根作为躯体-自主神经反射通路的传入分支保持完整。结果：术前尿动力学检查显示膀胱功能障碍有两种类型：无反射性膀胱14例，反射亢进性膀胱伴逼尿肌外括约肌协同失调6例。所有的孩子都失禁了。20例患者中17例在VR显微吻合术后8 ~ 12个月内获得满意的膀胱控制和排尿功能。14例无反射膀胱患者中12例（86%）显示改善。在这些病例中，膀胱容量从117.28 ml增加到208.71 ml，平均最大逼尿肌压力从18.35 cm H2O增加到32.57 cm H2O。6例反射亢进性膀胱患者中有5例表现出改善，尿失禁消退。尿动力学研究显示，这些病例从逼尿肌反射亢进伴逼尿肌外括约肌协同失调和逼尿肌压力升高转变为几乎正常的储尿和协同排尿。在这些病例中，平均膀胱容量从94.33 ml增加到177.83 ml，排尿后残余尿从70.17 ml减少到23.67 ml。总的来说，3例患者未能表现出任何improvement.Conclusions：人工体神经-自主神经反射弧程序是一种有效和安全的治疗方法，以恢复膀胱功能和扭转膀胱功能障碍的脊柱裂患者。
Purpose: Neurogenic bladder is a major problem for children with spina bifida. Despite rigorous pharmacological and surgical treatment, incontinence, urinary tract infections and upper tract deterioration remain problematic. We have previously demonstrated the ability to establish surgically a skin-central nervous system-bladder reflex pathway in patients with spinal cord injury with restoration of bladder storage and emptying. We report our experience with this procedure in 20 children with spina bifida.Materials and Methods: All children with Spina bifida and neurogenic bladder underwent limited laminectomy and a lumbar ventral root (VR) to S3 VR microanastomosis. The L5 dorsal root was left intact as the afferent branch of the somatic-autonomic reflex pathway after axonal regeneration. All patients underwent urodynamic evaluation before and after surgery.Results: Preoperative urodynamic studies revealed 2 types of bladder dysfunction-areflexic bladder (14 patients) and hyperreflexic bladder with detrusor external sphincter dyssynergia (6). All children were incontinent. Of the 20 patients 17 gained satisfactory bladder control and continence within 8 to 12 months after VR microanastomosis. Of the 14 patients with areflexic bladder 12 (86%) showed improvement. In these cases bladder capacity increased from 117.28 to 208.71 ml, and mean maximum detrusor pressure increased from 18.35 to 32.57 cm H2O. Five of the 6 patients with byperreflexic bladder demonstrated improvement, with resolution of incontinence. Urodynamic studies in these cases revealed a change from detrusor hyperreflexia with detrusor external sphincter dyssynergia and high detrusor pressure to nearly normal storage and synergic voiding. In these cases mean bladder capacity increased from 94.33 to 177.83 ml, and post-void residual urine decreased from 70.17 to 23.67 ml. Overall, 3 patients failed to exhibit any improvement.Conclusions: The artificial somatic-autonomic reflex arc procedure is an effective and safe treatment to restore bladder continence and reverse bladder dysfunction for patients with spina bifida.