尿动力学因素对子宫颈癌广泛性子宫切除术后尿潴留的影响  

Influence of urodynamic factors on urinary retention in patients with cervical carcinoma after radical hysterectomy

作　　者：陈贤璟[1] 宋一一[1] 蔡良知[1] 杜开洪[1] 林超琴[1] 苏彦钊[1] 俞进[1] 

机构地区：[1]福建省妇幼保健院妇科,福州350001

出　　处：《中华妇产科杂志》2010年第9期677-681,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 探讨尿动力学因素对宫颈癌广泛性子宫切除术后尿潴留的影响.方法 对2006年6月-2009年8月间福建省妇幼保健院收治的72例术前尿动力学检查正常的宫颈癌Ⅰb1～Ⅱa期患者,根据术后是否存在尿潴留分为尿潴留组和非尿潴留组,对两组患者进行术后尿动力学检查,并通过logistic回归模型分析尿动力学因素对宫颈癌广泛性子宫切除术后尿潴留的影响.结果 72例患者中,21例患者发生术后尿潴留,发生率为29%.尿潴留组和非尿潴留组患者术后膀胱初感容量分别为（171±61）和（134±39）ml,均高于术前[分别为（126±28）和（119±17）ml],分别比较,差异均有统计学意义（P＜0.05）;而术后膀胱最大容量[分别为（337±66）和（300±66）ml]、顺应性[分别为（31±25）和（29±18）ml/cm H2O（1 cm H2O=0.098 kPa）]、最大尿流率[分别为（10±4）和（12±5）ml/s]及最大尿流率时逼尿肌压力[分别为（27±9）和（32±8）cm H2O],均低于术前,分别比较,差异均有统计学意义（P＜0.05）;且尿潴留组术后的尿动力学改变较非尿潴留组明显（P＜0.05）.单因素分析显示,术后逼尿肌受损（OR=8.20,95%CI：2.62～25.66,P＜0.01）和膀胱感觉缺失（OR=6.90,95%CI：1.95～24.43,P＜0.01）与术后尿潴留有明显相关性,而术后低顺应性膀胱（OR=1.99,95%CI：0.70～5.63,P=0.195）、逼尿肌过度活动（OR=2.51,95%CI：0.73～8.67,P=0.144）、膀胱流出道梗阻（OR=3.77,95%CI：0.76～18.57,P=0.104）和逼尿肌外括约肌协同失调（OR=2.67,95%CI：0.49～14.45,P=0.255）与术后尿潴留无明显相关性;逼尿肌过度活动与逼尿肌受损间具有明显的拮抗作用（OR=7.60,95%CI：1.43～40.39,P=0.017）.多因素分析显示,逼尿肌受损（OR=7.01,P＜0.01）和膀胱感觉缺失（OR=5.45,P=0.018）是影响术后尿潴留的独立危险因素.结论 宫颈癌广泛性子宫切除术后患者尿动力学改变明显,逼尿肌受损与膀胱感觉缺�Objective To study the effect of urodynamic factors on the urinary retention of the patients with cervical cancer received radical hysterectomy. Methods Seventy-two patients with cervical cancer Ininternational Federation of Gynecology and Obstetrics （FIGO） stage Ⅰ bl to Ⅱ a hospitalized in Fujian Provincial Maternity and Child Health Hospital between June 2006 and August 2009, who were not found any abnormal representation of urodynamics before the operation, were divided into the group with urinary retention and the group without urinary retention based on whether urinary retention after the operation. All patients were detected by urodynamic examination following radical hysterectomy. Data obtained from urodynamic examination were analysed by logistic regression to evaluate the influence of urodynamic factors on the urinary retention postoperation. Results Twenty-one patients out of all were found with urinary retention after the operation , the incidence rate of urinary retention was 29%. The first sensation after operation in both groups were increased significantly than those before operation[ （ 171 ±61 ）ml vs.（126 ±28）ml, （134±39）ml vs. （119 ± 17）ml,all P〈0.05], while the maximum volume[ （337 ±66） and （300 ±66）ml, respectively], the compliance[ （31 ±25） and （29 ± 18） ml/cm H2O （1 cm H2O =0. 098 kPa）, respectively], the maximum flow rate[ （10 ±4） and （12 ±5） ml/s, respectively] and the pressure at the maximum flow rate [ （27 ±9） and （32 ±8） cm H2O, respectively] were decreased obviously after radical hysterectomy in both the group with urinary retention and the group without urinary retention （ all P 〈0.05）, compared with the corresponding value before the operation. The urodynamic changes in urinary retention group was much more severe than those in group without urinary retention （ P 〈 0. 05 ）. The single factor analysis results showed that bladder destusor dysfunction （ OR = 8. 20, 95% CI： 2.62 - 25. 66, P 〈0. 01

关 键 词：宫颈肿瘤 子宫切除术 手术后并发症 尿潴留 尿动力学 

分 类 号：R686[医药卫生—骨科学]