回肠代膀胱术后尿动力学特征表现及上尿路损害高危因素研究  

Urodynamic features and high risk factors of upper urinary tract deterioration for orthotopic ileal neobladder:report of 105 cases

作　　者：张瑞莉[1] 娄安锋[1,2] 王庆伟[3] 刘会范[1] 张国贤[1,2] 王焱[1,2] 魏金星[3] 文建国[1,2] 

机构地区：[1]郑州大学第一附属医院尿动力学中心 [2]河南省高等学校临床医学重点学科开放实验室,郑州450052 [3]郑州大学第一附属医院泌尿外科

出　　处：《第三军医大学学报》2009年第19期1835-1838,共4页Journal of Third Military Medical University

基　　金：国家自然科学基金(30571931);河南省医学科技攻关计划(200801002);郑州市技术研究与开发经费支持项目(074SGHH32262)~~

摘　　要：目的探讨W形原位回肠代膀胱术后尿动力学特征表现及上尿路功能损害高危因素。方法回顾性分析105例[年龄39～68(54±10)岁,男性90例,女性15例]W形原位回肠代膀胱患者术后[6～36(20±6)个月,为代膀胱组]随访资料,包括尿动力学检查、泌尿系彩超、肾功能、膀胱排尿造影和排尿表现。并选取20例患者[年龄40～70(56±10)岁,男性15例,女性5例]因上尿路疾病需要手术治疗而下尿路功能正常的患者作为正常膀胱组。比较代膀胱组和正常膀胱组相关参数的变化。同时,根据有无膀胱输尿管返流将行膀胱排尿造影的代膀胱患者分为有返流组和无返流组,比较2组相应参数变化。结果代膀胱组尿流曲线为间断或低平尿流曲线,正常膀胱组为钟形尿流曲线;代膀胱组最大尿流率[(12±4)ml/s]显著低于正常膀胱组[(21±5)ml/s],而残余尿量、最大代膀胱容量分别为(47±22)、(533±166)ml,显著高于正常膀胱组(8±7)、(412±57)ml。代膀胱组代膀胱感觉减退,无明显尿意感,稳定性较好,仅有9例出现蠕动波,波幅较低,规律出现,并随灌注量增多频率先逐渐增加后降低,多不伴有明显感觉。共有90例(86%)患者术后3个月膀胱排尿造影随访时未见膀胱输尿管返流。但随着随访时间延长,有11例(12%)出现膀胱输尿管返流。膀胱输尿管返流患者残余尿量、最大代膀胱容量、排尿期最大代膀胱压及颈口开放不良发生率显著高于无返流患者。结论W型原位回肠代膀胱具有不同于正常膀胱组织特征的尿动力学表现,残余尿量、代膀胱容量、排尿期膀胱压及膀胱颈口开放不良是其上尿路功能损害的尿动力学高危因素。Objective To investigate the urodynamie features and the relative high risk factors of upper urinary tract deterioration for W-shape orthotopic ileal neobladder. Methods One hundred and five patients （90 men and 15 women; mean age, 54 ± 10） which had follow-up data of W-shape orthotopic ileal neobladder （mean time 20 ± 6 months, ileal neobladder group） , and 20 patients （ 15 men and 5 women; mean age, 56 ± 10, control group） with upper urinary tract diseases who had normal lower urinary tract function were included in this retrospective study. All patients were evaluated by urodynamic examinations, cystourethrography, B-ultrasound, renal function test and voiding feature. The related parameters from both groups were analyzed comparatively. Meanwhile patients who were evaluated by cystourethrography in orthotopic ileal neobladder group were divided into 2 groups, reflux group and non-reflux group according to they having vesicoureteral reflux or not. The related parameters from both groups were analyzed comparatively. Results Urine flow curve was interrupted or plateau shape in ileal neobladder group, but it was bell shape in control group. Maximum flow rate was 12 ±4 ml/s, significantly lower than it in control group （21 ±5 ml/s）. However, postvoid residual urine volume （PVR） and maximum cystometric capacity （MCC） were 47 ± 22 and 533 ± 166 ml respectively in orthotopie ileal neobladder group, significantly higher than those in control group （8 ± 7 and 412 ± 57 ml, P 〈 0.05）. In contrast to the normal bladder, ileal neobladder had markedly decreased sensation, good stability, and not significantly desire to void. There were merely 9 patients having observed peristaltic wave, which having lower amplitudes in a certain rule and the frequency was gradually increased then reduced with augmented priming volume. In 3 months＇ postoperative followed-up, there were 90 patients having no vesicoureteral reflux observed by cystourethrography, but 11 patients had vesicoureteral reflux

关 键 词：原位回肠代膀胱 尿动力学 尿流改道术 

分 类 号：R318.01[医药卫生—生物医学工程] R693.501[医药卫生—基础医学]