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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 王炯珵 | 小孩白天尿失禁晚上尿床和腺樣體腫大有關嗎 | 2006/9/11 上午 09:48:56 | 0 |
| 原 文 | 題 目 | Resolution of diurnal incontinence and nocturnal enuresis after adenotonsillectomy in children. |
| 作 者 | Firoozi F, Batniji R, Aslan AR, Longhurst PA, Kogan BA | |
| 出 處 | Journal of Urology | |
| 出版日期 | 2006 May;175(5):1885-8 | |
| 評 論 |
過去研究顯示引起尿床的原因有可能和睡眠喚起功能障礙、夜間多尿、夜間膀胱容量小、遺傳因素、心理因素等諸多所因素構成，而腺樣體腫大則是一個最近發現可能引起兒童尿床的原因。 腺樣體存在於口腔深部，是一圈環狀的淋巴組織，由一顆顆小淋巴結串連而成，平時不會有任何症狀，但當有發炎現象或上呼吸道感染時就會造成問題，致病菌包括A群鏈球菌、腺病毒、流感病毒、腸病毒等引起，其常見症狀為鼻咽部腺樣體腫大，造成鼻塞、打呼、張口呼吸，如果腺樣體增大阻塞耳咽管開口，將會併發中耳炎、中耳積液；另口咽部腺樣體腫大，將會造成阻塞呼吸道，導致睡眠中呼吸暫停的情形發生。 腺樣體腫大會造成尿床可能的原因根據分析可能有兩個原因：一是上呼吸道阻塞會使兒童呼吸費力因而腹壓增加而導致膀胱壓力，進而增加產生尿床的情形發生。二是在睡眠呼吸中止的病人中，抗利尿荷爾蒙量分泌不足這也是增加夜尿的因素。 來自紐約Dr.Firoozi針對夜尿與呼吸道阻塞的相關聯性做了研究，發現在86個有上呼吸阻塞，腺樣體腫大的孩童裡，在切除腺扁桃體後有42%的病人夜尿的情形發生明顯減少，很特別的是白天頻尿與偶發的白天遺尿也會隨之減少。 腺樣體腫大是會引起兒童夜尿的一個重要因素，研究証實，若家中小孩有長期尿床的情形時，醫師應該詢間家長小孩是否有鼻塞、打呼、張口呼吸及睡眠中呼吸暫停等上述的症狀，若有上述症狀則應建議家長帶往耳鼻喉科就診，並朝腺樣體腫大的方向治療，或許可以對小孩一直治不好的尿床有幫助。 |
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| abstract |
PURPOSE: Adenotonsillar hyperplasia causes upper airway obstruction, leading to obstructive sleep apnea. We reviewed the incidence of nocturnal enuresis in a population of children with adenotonsillar hyperplasia. In addition, we investigated the rate of resolution or improvement in enuresis following surgery for relief of adenotonsillar hyperplasia. MATERIALS AND METHODS: We studied 86 consecutive prepubertal children, 46 boys and 40 girls, who underwent adenotonsillectomy. Severity of adenotonsillar obstruction was graded on a scale of 1 to 4. A questionnaire regarding voiding problems, including nocturnal enuresis, voids per day and daytime enuresis episodes, was filled out preoperatively and postoperatively by the patients and their parents. RESULTS: Among the 86 patients who underwent adenotonsillectomy 36 (42%) had nocturnal enuresis. In patients with nocturnal enuresis the number of episodes was significantly less after adenotonsillectomy. Overall, 12 patients (33%) had complete resolution, 11 (31%) had significant improvement and 13 (36%) showed no change. In addition, we noted a significant decrease in daytime enuresis episodes and voids per day. CONCLUSIONS: Children with upper airway obstruction have a high rate of nocturnal enuresis that improves at twice the anticipated rate after treatment of the airway obstruction. In addition, we observed that daytime voiding dysfunction improves in these patients. |
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