Zhou Zhaokai,Yang Shuai,Yu Jiating,et al.Urodynamic changes and clinical significance before and after detethering surgery[J].Journal of Clinical Pediatric Surgery,2023,22(08):731-736.[doi:10.3760/cma.j.cn101785-202211042-006]
脊髓栓系综合征患儿脊髓栓系松解术后尿动力学变化及临床意义
- Title:
- Urodynamic changes and clinical significance before and after detethering surgery
- Keywords:
- Eethered Cord Syndrome; Neurosurgical Procedures; Urodynamic Study; Minimal Clinically Important Difference; Child
- 摘要:
- 目的 通过比较脊髓栓系综合征（tethered cord syndrome，TCS）患儿脊髓栓系松解术前后尿动力学检查（urodynamic study，UDS）结果，探讨脊髓栓系松解术对TCS患儿膀胱功能的影响。方法 本研究为回顾性研究，以2019年1月至2021年10月在郑州大学第一附属医院就诊的43例TCS患儿为研究对象，收集患儿接受脊髓栓系松解术前后的UDS参数，并对部分UDS参数进行量化评分，分析手术前后变化。UDS评分由UDS参数量化后相加获得。本研究依据患儿手术前UDS参数和下尿路症状将患儿分为膀胱功能正常组（Normal组）和膀胱功能异常组（Abnormal组），对比两组患儿手术后UDS参数及下尿路症状的变化特征，评估TCS患儿手术后膀胱功能情况。结果 43例患儿手术时年龄（4.0±4.5）岁，均符合纳入条件。脊髓栓系松解术前后TCS患儿结果显示，手术前后膀胱逼尿肌-括约肌协同性[1.00（0.00，1.00）分比1.00（0.00，2.00）分]和UDS评分[4.00（2.00，7.00）分比6.00（1.00，9.00）分]差异具有统计学意义（P<0.05）；手术前后最大尿流率[12.00（9.00，13.00） mL/s比12.00（5.00，15.00） mL/s]、残余尿量[20.00（7.00，50.00） mL比20.00（5.00，40.00） mL]、最大膀胱容量[0.00（0.00，1.00）分比0.00（0.00，1.00）分]、膀胱顺应性[1.00（0.00，2.00）分比1.00（0.00，2.00）分]、逼尿肌活动[2.00（1.00，3.00）分比3.00（0.00，4.00）分]差异均无统计学意义（P>0.05）。Normal组24例（55.8%），Abnormal组19例（44.2%），两组性别构成比[10例（41.7%）比9例（47.4%），χ2=0.140]、下肢运动和感觉功能障碍改善比例[17例（70.8%）比14例（73.7%），χ2=0.029]、下肢运动和感觉功能障碍改善比例[19例（79.2%）比11例（57.9%），χ2=2.275]差异均无统计学意义（P>0.05）；Abnormal组术后膀胱功能障碍改善比例高于Normal组[14例（73.7%）比8例（33.3%），χ2=6.910]，差异具有统计学意义（P<0.05）。结论 TCS松解术可以改善部分手术前有膀胱功能障碍患儿的膀胱功能。对手术前无膀胱功能障碍的患儿，TCS松解术可引起部分患儿膀胱功能损害。因此后者应慎重进行TCS松解术。
- Abstract:
- Objective To explore the effect of detethering surgery on bladder function by comparing the results of urodynamic studies (UDS) before and after detethering surgery in children with tethered cord syndrome (TCS).Methods A total of 43 children diagnosed with TCS at First Affiliated Hospital of Zhengzhou University from January 2019 to October 2021 were recruited.The UDS parameters before and after detethering surgery were collected.Some UDS parameters were quantified and scored for examining the changes before and after surgery.According to preoperative UDS parameters and lower urinary tract symptoms, they were assigned into two groups of normal bladder function (normal group, n=24) and abnormal bladder function (abnormal group, n=19).The changes in UDS parameters and lower urinary tract symptoms were compared between two groups to assess the postoperative function of urinary system.Results The operative age was (4.0±4.5) years.Pre/post-operative urodynamic results showed statistically significant differences in bladder detrusor sphincter synergy[1.00(0.00, 1.00) vs.1.00 (0.00, 2.00)]and UDS scores[4.00(2.00, 7.00) vs.6.00(1.00, 9.00)]were statistically significant before and after the procedure (P<0.05); maximal flow rate[12.00(9.00, 13.00) vs.12.00(5.00, 15.00) mL/s], post void residual[20.00(7.00, 50.00) vs.20.00(5.00, 40.00) mL], maximal bladder capacity[0.00(0.00, 1.00) vs.0.00(0.00, 1.00)], bladder compliance[1.00(0.00, 2.00) vs.1.00(0.00, 2.00)]and bladder compliance[2.00(1.00, 3.00) vs.3.00(0.00, 4.00)].The differences were not statistically significant (P>0.05).Ratio of gender composition between two groups[(n=10, 41.7%) vs.(n=9, 47.4%), χ2=0.140], proportion of improvement in motor/sensory dysfunction of lower limbs[(n=17, 70.8%) vs.(n=14, 73.7%), χ2=0.029]and proportion of improvement in lower limb motor/sensory dysfunction[(n=19, 79.2%) vs.(n=11, 57.9%), χ2=2.275].The differences were not statistically significant (P>0.05); proportion of improvement in postoperative bladder dysfunction was higher in abnormal group than in normal group[(n=14, 73.7%) vs.(n=8, 33.3%), χ2=6.910]with a statistically significant difference (P<0.05).Conclusion Detethering surgery may improve bladder dysfunction in some children with preoperative bladder dysfunction.In children without preoperative bladder dysfunction, detethering surgery may cause bladder function impairment.Therefore detethering surgery should be performed with a great caution.
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备注/Memo
收稿日期:2022-11-21。
基金项目:国家自然科学基金（U1904208）
通讯作者:文建国,Email:wenjg@hotmail.com