超声测定逼尿肌厚度在无创诊断膀胱出口梗阻中的应用  

The Application of Ultrasound Assessment of Detrusor Wall Thickness for Non-invasive Diagnosis of Bladder Outlet Obstruction

作　　者：李宁[1] 王敏[2] 李永智[1] 宫雪[1] 刘屹立[1] 王平[1] 

机构地区：[1]中国医科大学附属第四医院泌尿外科,沈阳110032 [2]中国医科大学附属第一医院手术室,沈阳110001

出　　处：《中国医科大学学报》2010年第12期1055-1057,共3页Journal of China Medical University

摘　　要：目的探讨经超声逼尿肌厚度测定在无创诊断膀胱出口梗阻中的应用。方法 106例伴有下尿路症状的患者,在进行压力流率测定过程中,当膀胱容量为250ml时,应用7.5MHz高频线纵超声探头进行膀胱前壁逼尿肌厚度测定。通过A-G图进行膀胱出口梗阻的判定,将患者分为梗阻,可疑梗阻及非梗阻组,比较各组的逼尿肌厚度有无差异。应用相对工作特征曲线对逼尿肌厚度测定作为膀胱出口梗阻的诊断工具进行评价。结果梗阻组65例的逼尿肌厚度(2.6±0.5mm)明显高于可疑梗阻组(23例,2.0±0.4mm)及非梗阻组(18例,1.8±0.3mm)(P<0.01),可疑梗阻组及非梗阻组无显著性差异(P=0.16)。应用相对工作特征曲线,当临界值≥2.7mm时,特异度和阳性预测值均为100%,敏感度为39%,阴性预测值为51%。其曲线下面积为(0.88±0.03)。结论经超声逼尿肌厚度测定诊断膀胱出口梗阻,具有无创、方便、可靠的特点。当临界值≥2.7mm时,具有较高的特异度和阳性预测值,在一定程度上可取代压力流率测定诊断膀胱出口梗阻,但还需要进一步进行多中心、大样本的试验来证实临界值。Objective We estimated the diagnostic accuracy of ultrasound detrusor wall thickness（DWT）measurement for bladder outlet obstruction（BOO）and investigated the application of this non-invasive method for diagnosis BOO.Methods DWT was measured by linear ultrasound（7.5 MHz）at a flling volume of 250 ml in 106 men undergoing pressure flow study（PFS）for lower urinary tract symptoms（LUTS）.Obstruction was defined according to the Abrams-Griffiths nomogram.All the patients were divided into three groups according to obstructed,equivocal obstructed and unobstructed.We compared the DWT of the three groups and evaluated this method for diagnosing BOO through receiver operating characteristic（ROC）.Results DWT was significantly higher（P 〈 0.01）in obstructed（65 cases,2.6±0.5 mm） compared to unobstructed（18 cases,1.8±0.3 mm）as well as equivocal（23 cases,2.0±0.4 mm）cases.And there were no significantly difference between unobstructed and equivocal obstructed（P =0.16）.For a diagnosis of BOO,DWT of 2.7mm or greater had a positive predictive value of 100%,a negative predictive value of 51%,specificity of 100% and sensitivity of 39%.ROC analysis revealed that DWT had a high predictive value for BOO with an AUC of 0.88±0.03.Conclusion DWT measurement by ultrasound for BOO is non-invasive、convenient and reliable.Ultrasonographically assessed DWT 2.7 mm or thicker has a high positive predictive value and specificity for BOO and can replace PFS in some extent.However,this cutoff value needs to be validated in a larger sample and multiple centers.

关 键 词：超声 逼尿肌厚度 膀胱出口梗阻 尿动力学 

分 类 号：R694.2[医药卫生—泌尿科学]