Urological Management of Spinal Cord Injuries in Eastern Taiwan

台灣東部脊髓損傷病人之泌尿科處置

郭漢崇(Hann-Chorng Kuo)

《慈濟醫學雜誌》 7卷1期 (1995/03) Pp. 11-19

https://doi.org/10.6440/TZUCMJ.199503.0011

摘要

從1988年至1994年共有175位脊髓損傷病人在本院泌尿科處理其排尿障礙。其中72位為頸髓傷害，56位為腰髓傷害，47位為薦髓傷害。共有40位手術(22.7%)進行以治療其症狀以及腎功能變壞，包括22位尿道外括約肌切開術，12位腸膀胱擴大整型術，5位禁尿性尿放流及1位鐵氟龍尿道周圍注射。經過泌尿處置後之病人我們繼續追蹤其排尿品質及對現在排尿處置的滿意度。排尿處置必須考慮其(1)尿液排空(2)不會有感染(3)尿不失禁(4)不需使用導尿管(5)病人處置方便及不用服藥。大部份的病人均滿意或能接受目前的處置，只有16.1%病人希望作改變以改善其排尿生活品質。在不同部位之脊髓損傷滿意程度並無統計上的差異。共有15位病邁被發現有腎水腫，其中包括4.2%頸髓傷害者。所有腎臟水腫均在手術治療後消失。我們認為為了改善脊髓損傷病人之腎功能以及排尿品質，積極的泌尿科處置不但必要而且十分重要。

關鍵字

脊髓損傷 ； 神性排尿障礙 ； 生活品質 ； 泌尿科手術

並列摘要

175 spinal cord injury (SCI) patients with voiding dysfunction were followed up from 1988 to 1994. Among then 72 were cervical SCI, 56 were thoracolumbar and 47 were sacral SCI. A total of 40 surgical procedures were undertaken in order to treat their symptoms or upper urinary tract deteriorations. There were 22 external sphincterotomy, 12 augmentation cystoplasty, 5 continent diversion and 1 Teflon periurethral injection. The quality of urination was assessed and the satisfaction of voiding management was questioned for the patients who received uriological surgery. Only 16.1% of the patients wished for a change to improve their quality while the others were satisfied or accepted for their present outcome. There was no significant difference in the satisfaction rate among different levels of SCI. hydronephrosis was observed in 4.2% cervical, 8.9% thoracolumbar, and 15% sacral SCI. All were resolved after urological management. We conclude that aggressive urological managements are mandatory in treatment of upper urinary tract deterioration and in improvement of urination quality in SCI patients.

並列關鍵字

spinal cord injury ； neurogenic voiding dysfunction ； life quality ； urologic surgery