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題 名 | 外括約肌切開術治療逼尿肌外括約肌共濟失調之臨床經驗 |
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作 者 | 郭漢崇; 張世忠; 許悌; | 書刊名 | 慈濟醫學 |
卷 期 | 5:2 1993.06[民82.06] |
頁 次 | 頁105-111 |
分類號 | 416.274 |
關鍵詞 | 切開術; 外括約肌; 共濟失調; 治療; 逼尿肌; |
語 文 | 中文(Chinese) |
中文摘要 | 15位因頸髓傷害導致逼尿肌外括約肌共濟失調的病人在本院接受經尿 道外括約肌切開術(transure-thral external sphincoterotomy)。除了二例之外所有的病 人均有逼尿肌反射亢進(detrusor hyperreflexia,DH),及外括約肌協調不良的現象, 其中11例並有自主性反射異常(autonomic dysreflexia,AD)的現象。手術由膀胱頸至 球莖部尿道作一12點鐘方向之切開直至肌肉層完全切開。有3例必須重覆接受手 術。手術結果有1例仍需借助間歇性自行導尿,1例改為膀胱造�瓷A5例需借助Crede 壓迫以排空尿液,術後有效排尿比例為86.7(13/15)。手術效果良好的病人無需藉 導尿管排尿,殘尿量少,尿路感染亦可在手術後消除。(慈濟醫學 1993;5:105-111) |
英文摘要 | Transurethral external sphincterotomy (TUS) was undertaken in 15 patients with cervical spinal cord injuryand detrusor-extemal sphincter dyssynergia (DESD). All except 2 presented with detrusor hyperreflexia anddiscoordinated external sphincter. Autonomic dysreflexia was also noted in 11 patients. The surgery was performed at 12 o'clock position and the urethra was incised from the bladder neck to bulbous urethra. In 3 patientsrepeat TUS had to be done because of inadequate incision. Among the 15 patients, clean intermittent catheterization was necessary in 1 although 4 times of TUS had been performed; suprapubic cystostomy was requestedin I because of incomplete bladder emptying and incontinence, the remaining 13 patients were able to emptytheir bladder either freely (8) or assisted by Crede maneuver (5). The effectiveness of TUS in the treatment ofDESD was 86.7 (13/15). The end-filling pressure or leaking pressure was 58±24 CJpH,0.preoperatively-aod27±11 cmH�烙 postoperatively (p<0.05). Maximal urethral closure pressure decre3Sed from 69± 35.5-cmH��0 to31±15.6 cmH�烙 after TUS (p<0.05). Functional profile length also decreased, from 2.9±0.88 cm to 1.65±0.53cm (p<0.05). Three patients with upper tract deterioration had their.hydronephrosis resolved postoperatively.Autonomic dysreflexia was noted to reduce in degree in all patients. All 9 patients with urinary tract infectionwere free of infection after TUS. The results indicate that TUS is an effective treatment in patients with DESDand severe voiding dysfunction. (Tz'u-Chi Med J 1993; 5: 105-111) |
本系統中英文摘要資訊取自各篇刊載內容。