Sathi S, Madsen J R, Bauer S, Scott R M
Department of Neurosurgery, Children's Hospital, Boston, MA 02115.
Pediatr Neurosurg. 1993 Sep-Oct;19(5):256-9. doi: 10.1159/000120741.
Eighteen children under the age of 1 year underwent surgery for lipomeningocele at our institution between 1983 and 1991. All the patients had neurologic exams and urodynamic studies (UDS) including a cystometrogram and electromyography of the external urethral sphincter pre- and postoperatively. The surgical procedure performed included an untethering of the spinal cord, laser debulking of the lipoma and placement of a dural graft. All the infants presented with a lesion on their back. Two of 10 infants with a normal neurological exam had abnormal UDS preoperatively. Early surgery normalized abnormal preoperative UDS in 5 of 6 (83%) infants with abnormal UDS. Moreover, 3 of 8 (38%) infants with an abnormal neurological exam preoperatively improved after surgery and none worsened. These observations suggest that abnormal urinary tract function in infants with lipomeningocele may be reversible with early prophylactic surgery.
1983年至1991年间，18名1岁以下儿童在我们机构接受了脂肪瘤型脊膜膨出手术。所有患者在术前和术后均进行了神经学检查和尿动力学研究（UDS），包括膀胱压力测定和尿道外括约肌肌电图检查。手术操作包括脊髓松解、脂肪瘤激光减容和硬脑膜移植。所有婴儿背部均有病变。10名神经学检查正常的婴儿中有2名术前尿动力学研究异常。6名术前尿动力学研究异常的婴儿中，5名（83%）通过早期手术使术前异常的尿动力学研究恢复正常。此外，8名术前神经学检查异常的婴儿中，3名（38%）术后有所改善，无一例病情恶化。这些观察结果表明，脂肪瘤型脊膜膨出婴儿的异常尿路功能可能通过早期预防性手术得以逆转。
