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目的:探讨脊髓损伤后发生肾积水患者的影像尿动力学特点与处理原则,为脊髓损伤后并发肾积水的防治提供依据。方法:2002年12月至2008年6月我科对1393例脊髓损伤患者进行肾脏B超检查,发现肾积水患者169例,男157例,女12例。对这些患者进行影像尿动力学检查,分析其特点,并按其特点选择相应的处理方法。结果:肾积水占本组脊髓损伤患者的12%。5例因输尿管结石梗阻引起肾积水,影像尿动力学表现为逼尿肌过度活动伴逼尿肌括约肌协同失调,经碎石治疗后积水消失。164例因膀胱尿道功能障碍引起肾积水,其中57例有膀胱输尿管返流,107例无返流(52例为低顺应性膀胱,52例过早出现或持续逼尿肌收缩型明显协同失调,3例为输尿管壁段梗阻)。47例返流性肾积水者采用经膀胱引流处理(留置尿管或膀胱造瘘,括约肌注射肉毒毒素或括约肌切断),75例非返流性积水采用经膀胱储尿(口服抗胆碱能制剂,膀胱壁注射肉毒毒素,膀胱扩大加输尿管抗返流再植术)配合间歇导尿,肾积水均得到缓解或消失。10例有返流患者因个人意愿选择膀胱储尿配合间歇导尿,32例无返流患者因不接受间歇导尿选择膀胱引流处理,肾积水也均缓解或消失。结论:脊髓损伤后发生肾积水的患者影像尿动力学特点不尽相同,依据引起肾积水的不同机制特点进行处理可获得良好的疗效。
Objective: To investigate the imaging urodynamic characteristics and treatment principles of patients with hydronephrosis after spinal cord injury, and to provide evidence for the prevention and treatment of hydronephrosis complicated by spinal cord injury. Methods: From December 2002 to June 2008, 1393 kidney patients with spinal cord injury were examined by B-mode ultrasonography. 169 cases of hydronephrosis were found, including 157 males and 12 females. Imaging urodynamics of these patients, analyze their characteristics, and select the appropriate treatment according to their characteristics. Results: Hydronephrosis accounted for 12% of patients with spinal cord injury in this group. 5 cases of hydronephrosis caused by ureteral calculi caused by hydronephrosis, imaging urodynamics showed detrusor overactivity with detrusor sphincter coordination disorders, the water disappeared after gravel treatment. 164 cases of hydronephrosis caused by bladder and urinary tract dysfunction, of which 57 cases had vesicoureteral reflux, 107 cases had no reflux (52 cases of low compliance bladder, 52 cases of premature or persistent detrusor contractility obvious synergy , 3 cases of ureteral wall obstruction). 47 cases of reflux hydronephrosis by the bladder drainage (indwelling catheter or bladder fistula, sphincter injection of botulinum toxin or sphincter cut), 75 cases of non-reflux hydronephrosis by urinary bladder (oral anti-gallbladder Alkali preparation, injection of botulinum toxin in the bladder wall, bladder expansion plus ureteral anti-reflux replantation) with intermittent catheterization and hydronephrosis were alleviated or disappeared. 10 cases of patients with reflux due to personal preference for urinary bladder with intermittent catheterization, 32 cases of patients without reflux due to not choose intermittent catheterization bladder drainage, hydronephrosis also were relieved or disappeared. CONCLUSION: Urodynamic characteristics of patients with hydronephrosis after spinal cord injury are different. According to the different mechanisms of hydronephrosis, good results can be obtained.