神经源性膀胱 (Neurogenic bladder)

<IMGsrc="http://www.neuro-urol.org.cn/manage/editor/upload/2007729153062.JPG">
 
 
 
 
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt18pt;TEXT-INDENT:15pt;mso-para-margin-left:1.8gd;mso-char-indent-count:1.5">一.定义<SPANlang=EN-US><FONTface=Tahoma>:
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><SPANstyle="mso-spacerun:yes"><FONTface=Tahoma>   <SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">调节和控制排尿生理活动的中枢神经系统或周围神经受到损害而引起的膀胱及尿道功能障碍称为神经源性膀胱<SPANlang=EN-US><FONTface=Tahoma>（<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">功能障碍<SPANlang=EN-US><FONTface=Tahoma>）
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt;TEXT-INDENT:30pt;mso-char-indent-count:3.0"><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma"><FONTsize=2>二.病因学：
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>1.  <SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">脊髓或颅脑损伤。<SPANlang=EN-US> <FONTface=Tahomasize=2>2.  <FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">中枢神经手术或广泛盆腔手术<SPANlang=EN-US><FONTface=Tahoma>:<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">如直肠癌根治术、子宫癌根治术、盆腔淋巴结清除术等。<SPANlang=EN-US> <FONTface=Tahomasize=2>3.<FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">先天性疾病<SPANlang=EN-US><FONTface=Tahoma>:<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">如脊柱裂、脊髓脊膜膨出、骶骨畸形、骶骨发育不良等。<SPANlang=EN-US> <FONTface=Tahomasize=2>4.<FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">药物作用<SPANlang=EN-US><FONTface=Tahoma>:<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">对交感、副交感神经功能有影响的药物，如普鲁本辛、阿托品、酒、尼石丁以及用于降血压、脱敏、抗组织胺等药物均可影响排尿中枢神经。<SPANlang=EN-US> <FONTface=Tahomasize=2>5.<FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">某些疾病<SPANlang=EN-US><FONTface=Tahoma>:<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">糖尿病、梅毒、帕金森病、脊髓症质炎、脑炎、中风、脊髓炎等。<SPANlang=EN-US> <FONTface=Tahomasize=2>6.<FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">原因不明。<FONTface=Tahoma>
<IMGsrc="http://www.neuro-urol.org.cn/manage/editor/upload/2007729154040.JPG">
 
 
 
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt;TEXT-INDENT:25pt;mso-char-indent-count:2.5">三.分类：
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">神经源性膀胱分类的方法很多，过去常用的分类方法为<SPANlang=EN-US><FONTface=Tahoma>Bors<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">分类法，分类下列<SPANlang=EN-US><FONTface=Tahoma>5<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">类：<FONTface=Tahoma>
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>1.<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">上运动神经元病变：病变在脊髓中枢（<SPANlang=EN-US><FONTface=Tahoma>S2<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">～<SPANlang=EN-US><FONTface=Tahoma>S4<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">）<SPANlang=EN-US><SPANstyle="mso-spacerun:yes"><FONTface=Tahoma> <SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">以上，包括感觉支和运动支。
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>2.<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">下运动神经元病变：病变位于脊髓中枢（<SPANlang=EN-US><FONTface=Tahoma>S2<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">～<SPANlang=EN-US><FONTface=Tahoma>S4<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">）或中枢以下的周围神经，包括感觉支与运动支
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>3.<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">原发性运动神经元病变：病变只限于运动支，感觉支无病变，如脊髓灰质炎。
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>4.<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">原发生感觉神经元病变：病变只限于感觉支。运动神经元病变，如糖尿病及脊髓结核引起的神经原性膀胱。
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>5.“<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">混合<SPANlang=EN-US><FONTface=Tahoma>”<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">病变：有关排尿的自主运动神经元病变（副交感神经）与体运动神经元病变不在同一水平，其中一个在上运动神经元，另一个在下运动神经元，或一个有病变另一个无病变。<FONTface=Tahoma>
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt;TEXT-INDENT:20pt;mso-char-indent-count:2.0"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">这种分类方法虽较详尽，但太复杂，对治疗方法的选择缺乏指导意义。近年来国际上依膀胱充盈时逼尿肌有否无抑制性收缩分成二类<SPANlang=EN-US><FONTface=Tahoma>:
<OLstyle="MARGIN-TOP:0cm"type=1>
<LIclass=MsoNormalstyle="MARGIN:0cm0cm0pt;mso-list:l0level1lfo1;tab-stops:list36.0pt"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">逼尿肌反射亢进<FONTface=Tahoma><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">逼尿肌对刺激的反应有反射亢进现象，在测量膀胱内压时出现无抑制性收缩。可伴或不伴尿道括约肌的功能障碍。
<LIclass=MsoNormalstyle="MARGIN:0cm0cm0pt;mso-list:l0level1lfo1;tab-stops:list36.0pt"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">逼尿肌无反射<FONTface=Tahoma><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">这一类神经原性膀胱的逼尿肌对刺激无反射或反射减退。在测量膀胱内压时不出现无抑制性收缩。可伴或不伴尿道括约肌的功能障碍。<FONTface=Tahoma></LI></OL>
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt;TEXT-INDENT:25pt;mso-char-indent-count:2.5"><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma"><FONTsize=2>四.临床表现：
 
 
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<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>1.<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">排尿异常<SPANlang=EN-US><FONTface=Tahoma>:
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes"> （1）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">感觉异常<FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes"> （2）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">控制异常
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><SPANstyle="mso-spacerun:yes"><FONTface=Tahoma>     <SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">尿失禁
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><SPANstyle="mso-spacerun:yes"><FONTface=Tahoma>     <SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">排尿终止障碍
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes"> （3）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">排尿间隔时间延长<SPANlang=EN-US><FONTface=Tahoma>（<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">尿频<SPANlang=EN-US><FONTface=Tahoma>）<FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes"> （4）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">膀胱排空障碍<SPANlang=EN-US><SPANstyle="mso-spacerun:yes"><FONTface=Tahoma>  
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>2.<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">尿道外症状和体征
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes">  （1）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">排便功能障碍<FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes">  （2）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">性功能障碍<FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes">  （3）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">下肢及足部畸形<FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes">  （4）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">皮肤异常
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>3.<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">尿路并发症
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes">  （1）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">反复尿路感染<FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes">  （2）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">肾积水→肾功能衰竭<FONTsize=2><SPANlang=EN-US><FONTface=Tahoma><SPANstyle="mso-spacerun:yes">  （3）<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">尿路结石
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt;TEXT-INDENT:15pt;mso-char-indent-count:1.5"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">五.膀胱尿道造影<SPANlang=EN-US><FONTface=Tahoma>（<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">正常<SPANlang=EN-US><FONTface=Tahoma>）
 
 
 
<IMGsrc="http://www.neuro-urol.org.cn/manage/editor/upload/2007729153123.jpg">
 
<IMGsrc="http://www.neuro-urol.org.cn/manage/editor/upload/2007729153140.jpg">
 
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt;TEXT-INDENT:15pt;mso-char-indent-count:1.5"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">六.神经源性膀胱<SPANlang=EN-US><FONTface=Tahoma>X<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">线表现<SPANlang=EN-US><FONTface=Tahoma>:
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt;TEXT-INDENT:15pt;mso-char-indent-count:1.5"><FONTsize=2><SPANlang=EN-US> 
<IMGsrc="http://www.neuro-urol.org.cn/manage/editor/upload/2007729153364.JPG">
 
 
 
 
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">图<SPANlang=EN-US><FONTface=Tahoma>1<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">膀胱壁不规则<SPANlang=EN-US><FONTface=Tahoma>,<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">有小梁及多个憩室形成<SPANlang=EN-US><FONTface=Tahoma>,<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">双侧输尿管有反流<SPANlang=EN-US><FONTface=Tahoma>,<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">肾盂重度积水<SPANlang=EN-US><FONTface=Tahoma>.
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">图<SPANlang=EN-US><FONTface=Tahoma>2<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">膀胱成葫芦型<SPANlang=EN-US><FONTface=Tahoma>,<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">壁不规则<SPANlang=EN-US><FONTface=Tahoma>,<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">有小梁及多个憩室形成<SPANlang=EN-US><FONTface=Tahoma>,<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">双侧输尿管有反流<SPANlang=EN-US><FONTface=Tahoma>,<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">膀胱颈成漏斗样扩张<SPANlang=EN-US><FONTface=Tahoma>.
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt;TEXT-INDENT:15pt;mso-char-indent-count:1.5"><FONTsize=2><SPANlang=EN-US><FONTface=Tahoma>七.X<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">线表现：
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">①<FONTface=Tahoma><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">膀胱的改变<SPANlang=EN-US><FONTface=Tahoma>:<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">整个膀胱呈棱形或近似三角形，底部宽，上部窄，好像一个塔状。亦可形成各种不规则形态。膀胱壁边缘高低不平，呈多个小的波浪状向内凹陷的小梁，在小梁之间有多个向外凸出的小憩室。憩室常多发，大小不等，多数不大，但也可有个别或几个较大的憩室。另一种改变是膀胱低张力，整个膀胱重度扩张，边缘光滑，但此改变并非特征性，也可见于膀胱颈或膀胱颈以下的梗阻性疾病，如前腺肥大、后尿道瓣膜形成和尿道损伤后狭窄等。
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><SPANlang=EN-US><?xml:namespaceprefix=ons="urn:schemas-microsoft-com:office:office"/><o:p><FONTface=Tahomasize=2> </o:p>
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">②输尿管返流<SPANlang=EN-US><FONTface=Tahoma>:<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">多数病人有不同程度的返流，严重者可引起输尿管及。肾盂发生扩张及积水现象。返流大多为两侧性，也可仅见于一侧。
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><SPANlang=EN-US><o:p><FONTface=Tahomasize=2> </o:p>
<Pclass=MsoNormalstyle="MARGIN:0cm0cm0pt"><FONTsize=2><SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">③膀胱颈的改变<SPANlang=EN-US><FONTface=Tahoma>:<SPANstyle="FONT-FAMILY:宋体;mso-ascii-font-family:Tahoma;mso-hansi-font-family:Tahoma">膀胱内括约肌麻痹，则膀胱底与尿道相接处呈漏斗样扩张。相反如内括约肌痉挛，则膀胱颈呈细线样。
 
 
 
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神经源性膀胱 (Neurogenic bladder)

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