张衍辉+余航+陈书煌+熊俊

【摘要】 目的：观察尿道外括约肌牵张治疗神经源性膀胱排尿障碍的疗效。方法：选择存在神经源性膀胱的40例男性脊髓损伤患者，随机数字表法分为治疗组和对照组各20例，对照组患者仅进行单纯间歇导尿治疗，治疗组患者在单纯间歇导尿治疗的基础上加以球囊牵张尿道外括约肌治疗。观察治疗前后两组患者24 h间歇导尿次数、残余尿量、最大尿道压、排尿方式的变化。结果：经治疗后两组患者残余尿量、间歇导尿次数、最大尿道压及排尿方式等方面均有改善，但治疗组改善情况优于对照组，两组比较差异均有统计学意义（P<0.05）。结论：尿道外括约肌的牵张治疗神经源性膀胱可以减少间歇导尿次数、减小尿道流出道阻力、降低残余尿量，有利于自主排尿恢复；该技术具有安全简便易于操作，副作用小、不良反应少、选择性高等优点，便于推广使用。

【关键词】 神经源性膀胱； 排尿障碍； 牵张； 球囊扩张； 间歇导尿

Clinical Observation of the Therapeutic Effects of External Urethral Sphincter Distraction on Neurogenic Bladde/ZHANG Yan-hui， YU Hang， CHEN Shu-huang， et al.//Medical Innovation of China，2014，11（31）：012-014

【Abstract】 Objective： To investigate the therapeutic effects of external urethral sphincter distraction on neurogenic blade. Method： 40 male neurogenic bladde patients with spinal cord injury were recruited in this study. The patients were divided randomly into two groups， each contained 20 cases. The control group was only treated by intermittent catheterization， and the treatment group was treated by ballon dilation of external urethral sphincter and intermittent catheterization. Changes of 24 hours intermittent catheterization times， residual urine volume， maximum urethral pressure and micturition mode of the two groups were studied. Result： In treatment group， residual urine volume of 18 patients was less than 100 mL （15 cases with recovery of automatic micturition， 3 cases with micturition rely on abdominal pressure）， and residual urine volume of 2 patients decreased. And， maximum urethral pressure and intermittent catheterization times reduced. Reducing the residual urine volume and the number of catheterization of the treatment groups was better than that of the control group （P<0.01）. Conclusion： The treatment group is significantly more improved the situation of urinary dysfunction than the control group. The therapy of ballon dilation of external urethral sphincter can reduce the residual urine volume， maximum urethral pressure， urethral catheterization times， and is conducive to the recovery of automatic micturition. The combined treatment of ballon dilation of external urethral sphincter and intermittent catheterization is more effective in external urethral sphincter distraction.

【Key words】 Neurogenic Bladder； Urination Disorders； Stretch； Balloon Dilatation； Intermittent Catheterization

First-authors address： The Affiliated Hospital of Jiangxi University of TCM， Nanchang 330006， China

doi：10.3969/j.issn.1674-4985.2014.31.004endprint

神经源性膀胱是指控制膀胱的中枢或周围神经伤病引起的排尿功能障碍（即储尿和∕或排尿功能障碍）[1]。神经源性膀胱是康复医学中常见的并发症之一，可以由外伤、多种神经系统疾病、药物等原因引起，尤其多见于脊髓损伤。排尿障碍型是临床常见神经源性膀胱的类型，主要症状为排尿困难，残余尿增多，常因为膀胱内压力增高和膀胱顺应性降低引起肾积水和肾功能损害，最终导致患者肾功能衰竭，使生活质量下降[2]。康复治疗的首要目标是利用适当的尿液引流方式，使膀胱具有排空能力同时具备适当的控尿能力，以达到膀胱内低压性尿存留和低压性尿排泄，防止尿液反流，减少肾功能损害，提高生存质量[3]。

尿道外括约肌不能松弛（张力增高）是排尿障碍的机制之一[4]，目前国内外针对此机制没有特异性的治疗方法[5]。……