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| 題 名 | Bladder Autoaugmentation in Treatment of Neuropathic Bladder Dysfunction=以膀胱自行擴大術治療神經性膀胱功能障礙 |
|---|---|
| 作 者 | 郭漢崇; | 書刊名 | 慈濟醫學 |
| 卷 期 | 9:3 1997.09[民86.09] |
| 頁 次 | 頁191-197 |
| 分類號 | 415.83 |
| 關鍵詞 | 神經性膀胱障礙; 膀胱自行擴大術; Neuropathic bladder; Bladder autoaugmentation; |
| 語 文 | 英文(English) |
| 中文摘要 | 為了治療神經性膀胱功能障礙,作者使用膀胱自行擴大術於6位慢性脊髓損傷的男性病人。 其中有4位為低適應性膀胱,2位為逼尿肌反射亢進。所有的病人均有尿失禁的問題,其中2位具 有腎水腫。兩位逼尿肌反射亢進的病人曾經接受過尿道外括約肌切開術以治療其逼尿肌外括約肌共 濟失調。在手術進行中我們只剝離膀胱之肌肉層而不傷及粘模層,使得粘膜向外膨出而達到增加膀 胱容量及降低膀胱內壓的目的。手術後導尿管留置3天並給予抗生素,在進行膀胱造影數確定沒有 漏尿後即開始關閉導尿管使膀胱膨脹,並於第5天拔除導尿管。在手術後第7天病人的膀胱最大容 量由135±45mL 增加到323±70mL,膀胱最終灌注壓力則由術前47±14cmH□O降低至34±10 cmH□ O,膀胱適應性亦由手術前之8±7.5增加至 26.7±26.7,手術並無任何併發症或後遺症。在術後追 蹤6個月後有3位病人完全可禁尿,但仍有3位病人在漲尿時會有漏尿情形。此3位病人膀胱容量 明顯縮小,其中2位為具有逼尿肌反射亢進及膀胱外閉鎖不全,另1位則在術前有嚴重尿路感染, 手術當中黏膜層不斷破裂無法有效地剝離肌肉。由此初期的經驗顯示,膀胱自行擴大術對於某些小 心選擇的病人可以達到有效增加膀胱容量的效果。 |
| 英文摘要 | Bladder autoaugmentation was performed in 6 men suffering from chronic spinal cord injury with meurogenic bladder dysfunction. There were 4 patients with poor compliant bladders and 2 with detrusor hyperrefle.xia (DH). All patients suffered from urinary incontinence and 2 patients with DH had hydronephrosis. The 2 patients with DH had had external sphincterotomy for their detrusor external sphincter dyssynergia. The bladder muscle layer of all 6 men was dissected us widely as possible without perforating the mucosa. After the bladder wall was freed from the mucosa, the mucosa was buldging out and the bladder capacity increased. On the 7th postoperative day the bladder capacity increased from 135± 45mL to 323±70mL. The end-filling pressure decreased from 47±14cmH□O to 34±10 cmH□O. Bladder compliance also increased from 8±7.5 to 26.7±26.7. Three patients became continent after surgery while the other 3 were still incontinent on a full bladder. Postoperative morbidity and complications were few. Six months after surgery, however, the bladder capacity of 3 patients decreased again and severe urinary incontinence recurred. Of these 3 patients, 2 had DH and an incompetent bladder outlet and I had severe cysititis before surgery, which caused multiple perforations during surgery. This study concludes that bladder autoaugmentation is an effective method in increasing bladder capacity with low morbidity and complication in carefully selected neuropathic bladders. |
本系統中英文摘要資訊取自各篇刊載內容。