前列腺增生致膀胱出口梗阻后逼尿肌功能改变对尿动力学参数的影响  

Influence of detrusor function changes on urodynamic parameters caused by bladder outlet obstruction due to benign prostatic hyperplasia

作　　者：杨志刚[1] 张飞[1] 马旭东[1] 

机构地区：[1]包头市中心医院泌尿外科,内蒙古包头014040

出　　处：《现代泌尿外科杂志》2013年第6期568-571,共4页Journal of Modern Urology

摘　　要：目的探讨良性前列腺增生症(BPH)致膀胱出口梗阻(BOO)后逼尿肌功能改变对尿动力学参数的影响。方法 109例具有完整尿动力学结果的BPH患者根据有无BOO分为梗阻组和非梗阻组;梗阻组根据梗阻级别分Ⅲ、Ⅳ、Ⅴ、Ⅵ级4组;逼尿肌收缩力分为逼尿肌收缩力减弱(DCA)与收缩力正常组;逼尿肌不稳定(DI)分DI与非DI;膀胱顺应性(BC)分高、正常、低顺应性三组;28例患者行经尿道前列腺切除术(TURP)术前及术后尿动力参数对比。结果 BOO组的前列腺体积(PV)、国际前列腺症状评分(IPSS)、DI、急性尿潴留(AUR)发生率明显高于非BOO组(P<0.05);BOO组的最大尿流率(Qmax)、BC值、DCA发生率明显低于非BOO组(P<0.05);逼尿肌收缩力正常组的残余尿(RV)与BC值明显低于减弱组(P<0.05),而BOO和DI的发生率明显高于减弱组(P<0.01);DI组的年龄、BC值及DCA的发生率明显低于非DI组(P<0.05),而BOO级别和AUR的发生率明显高于非DI组(P<0.01);低BC组IPSS、BOO级别、AUR发生率明显高于正常及高BC组(P<0.05),而DCA发生率明显低于正常及高BC组(P<0.01);术后Qmax、BC值较术前明显升高(P<0.05),RV、IPSS、DI发生率较术前明显减小(P<0.01)。结论①BOO常与低顺应性膀胱、DI、AUR合并存在;②IPSS评分不能提示是否存在DI,DI的存在不影响IPSS评分;③TURP是治疗前列腺增生的金标准;④尿动力检查能全面了解有无BOO及BOO所致逼尿肌功能改变情况,对BPH的临床鉴别诊断、预后估计及选择恰当治疗方案都具有重要意义。Objective To discuss the influence of detrusor function changes on urodynamic parameters caused by bladder outlet obstruction （BOO） due to benign prostatic hyperplasia （BPH）. Methods A total of 109 patients with BPH were divided into the obstructive group and non-obstructive group. The obstructive group was subdivided into group Ⅲ, Ⅳ, Ⅴ and Ⅵ according to the seriousness of obstruction. The detrusor contractility was divided into normal and decreased contractility group （DCA） groups. Detrusor instability was divided into detrusor instability （DI） and non-DI group. Bladder compliance （BC） was classified into high, normal, and low compliance groups. The urodynamic parameters of 28 patients were compared before and after transurethral resection of the prostate （TURP） surgery. Results The prostate volume （PV）, International Prostate Symptom Score （IPSS）, DI incidence of acute urinary retention （AUR） were significantly higher in the BOO group than in the non-BOO group （P〈0.05） ; the maximum urinary flow rate （Qmax）, BC values, DCA were significantly lower in the BOO group than in the non-BOO group （P〈0.05）. In the normal contractility group, the residual urine volume （RV） was significantly lower than in the reduced contractility group （P〈0.05）, while the incidence of BOO, and DI was significantly higher （P〈0.01）. In the DI group, patients＇ age, BC value and DCA were significantly lower than in the non-DI group （P〈0. 05）, while the BOO-level and the incidence of AUR were significantly higher （P〈0.01）. The IPSS, BOO-level, AUR incidence were significantly higher in the low compliance group than in tlae normal and high compliance group （P〈0. 05）, while the incidence of DCA was significantly reduced （P 〈0.02）. After operation, Qmax and BC were significantly higher （ P 〈0.05）, while RV, IPSS and DI incidence were significantly reduced （P〈0.01）. Conclusions （1） BOO is often associated with low compliance bla

关 键 词：良性前列腺增生 膀胱出口梗阻 逼尿肌功能 尿动力学 

分 类 号：R695[医药卫生—泌尿科学]