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目的 探讨女性膀胱出口梗阻的诊断方法。方法收集了我科2005年1月至2009年12月收治的临床资料完整的64例疑似女性膀胱出口梗阻(FBOO)女性患者。患者平均年龄50岁(24~76岁),主诉有尿频、尿急、排尿时间延长、下腹部酸胀不适等下尿路症状(LUTS)。均无神经系统疾病史、无糖尿病等内分泌病史、无盆腔手术史、无尿道手术史,无泌尿系畸形及感染,而且体检结合辅助检查排除尿道肉埠、尿道憩室、子宫脱垂、尿道旁腺囊肿等疾病。采用LABOR IE公司生产的Avanti尿动力学检测仪对患者进行全面的尿动力学检查(包括最大尿流率、残余尿量、最大尿流率时逼尿肌压力、最大逼尿肌压力、最大尿道闭合压),同时行膀胱镜检查和排尿期尿道造影。FBOO膀胱镜检查依据为:膀胱颈后唇抬高,隆起,呈堤坝状;影像学依据为:排尿期膀胱颈关闭,开放不全或狭窄,或远端尿道狭窄,近端尿道扩张。结果膀胱镜检查和排尿期尿道造影证实64例患者中膀胱出口梗阻(FBOO)38例:最大尿流率(Qmax)平均为(9.42±2.62)m l/s,残余尿量(RV)平均为(92.62±120.23)m l,最大尿流率时逼尿肌压力(Pdet.Qmax)平均为(38.25±10.24)cmH2O,最大逼尿肌压力(Pdet.max)平均为(60.21±16.25)cmH2O,最大尿道闭合压(MUCP)平均为(95.142±0.13)cmH2O。无膀胱出口梗阻26例:最大尿流率(Qmax)平均为(13.23±4.46)m l±/s,残余尿量(RV)平均为(78.56±145.54)m l,最大尿流率时逼尿肌压力(Pdet.Qmax)平均为(15.47±5.56)cmH2O,最大逼尿肌压力(Pdet.max)平均为(28.2±66.45)cmH2O,最大尿道闭合压(MUCP)平均为(46.1316±0.25)cmH2O。FBOO组与无膀胱出口梗阻组比较,(Qmax)、(Pdet.Qmax)、(Pdet.max)、(MUCP)均有统计学差异。结论具有(LUTS)症状患者及单纯尿动力学检查不能诊断为FBOO,结合膀胱镜检和排尿期尿道造影检查可以确诊FBOO。
Objective To investigate the diagnosis of bladder outlet obstruction in women. Methods A total of 64 female patients with suspected bladder outlet obstruction (FBOO) were enrolled in our department from January 2005 to December 2009. The average age of patients was 50 years (range, 24 to 76 years). The chief complaint was lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, prolonged urination, and lower abdominal discomfort. No history of nervous system disease, no endocrine disease such as diabetes mellitus, no history of pelvic surgery, no history of urethral surgery, no urinary malformations and infections, and physical examination combined with auxiliary examination to exclude urethra, urethral diverticulum, uterine prolapse, Cysts and other diseases. Patients were subjected to a full urodynamic examination using the Avanti Urodynamic Tester manufactured by LABOR IE (including maximum flow rate, residual urine volume, detrusor pressure at maximal flow rate, maximal detrusor pressure, maximal urethra Closing pressure), while cystoscopy and urination during urethroplasty. FBOO cystoscopy is based on: the posterior lip of the bladder neck elevation, uplift, was levee-like; imaging based on: bladder neck during voiding stage closure, incomplete or narrow stenosis, or distal urethral stricture, proximal urethral dilatation. Results Cystoscopy and voiding urethroplasty confirmed 38 cases of bladder outlet obstruction (FBOO) in 64 patients: the mean maximal flow rate (Qmax) was (9.42 ± 2.62) ml / s and the average residual urine volume (RV) was 92.62 ± 120.23) ml, the average detrusor pressure (Pdet.Qmax) was (38.25 ± 10.24) cmH2O at the maximal uroflow rate, and the mean maximum detrusor pressure (Pdet.max) was (60.21 ± 16.25) cmH2O The mean closing pressure (MUCP) was (95.142 ± 0.13) cmH2O. No bladder outlet obstruction in 26 cases: the average maximum flow rate (Qmax) was (13.23 ± 4.46) ml ± / s, the average residual urine volume (RV) was (78.56 ± 145.54) ml, the maximum flow rate of detrusor pressure (Pdet.Qmax) averaged (15.47 ± 5.56) cmH2O, mean maximum detrusor pressure (Pdet.max) was (28.2 ± 66.45) cmH2O, and mean maximum urethral closure pressure (MUCP) was (46.1316 ± 0.25) cmH2O. FBOO group and no bladder outlet obstruction group, (Qmax), (Pdet.Qmax), (Pdet.max), (MUCP) were statistically significant. Conclusions Patients with (LUTS) symptoms and simple urodynamic tests can not be diagnosed as FBOO, and combined with cystoscopy and urinary urethra examination can confirm FBOO.