膀胱过度充盈对超声检查测量残余尿准确性的影响  

Effect of over filling bladder on the accuracy of post-voiding residual urine measurement

作　　者：刘毅[1] 刘志坚[1] 范宇[1] 李德润[1] 孟一森[1] 胡玉文[1] 李志华[1] 李淑清[1] 山刚志[1] 肖云翔[1] 

机构地区：[1]北京大学第一医院泌尿外科北京大学泌尿外科研究所,100034

出　　处：《中华泌尿外科杂志》2016年第5期368-371,共4页Chinese Journal of Urology

摘　　要：目的分析膀胱过度充盈对经腹部超声检查测量残余尿准确性的影响。方法收集2015年6—10月就诊的良性前列腺增生（BPH）患者146例。年龄38—88岁，平均（61．8±10．1）岁。前列腺特异抗原（PSA）O．3～59．8ng／ml，中位值2．0ng／ml。超声检查前列腺体积20．1～280．0cm3，中位值31．4cm3。最大尿流率1．3—40．4m／s，中位值14．0m／s。比较患者行经腹部超声检查时，膀胱过度充盈与膀胱适度充盈时的膀胱容量和残余尿量。分别以残余尿量50、60、100及200ml作为残余尿试验阳性临界点，比较膀胱过度充盈和膀胱适度充盈时的残余尿试验阳性率。结果本组146例患者，膀胱过度充盈时的中位膀胱容量和中位残余尿量分别为573ml和72ml，膀胱适度充盈时的中位膀胱容量和中位残余尿量分别为230ml和15ml，两组的残余尿量差异有统计学意义（P〈0．05）。以残余尿量50、60、100及200ml作为残余尿试验阳性临界点，膀胱过度充盈时分别有88例（60．3％）、80例（54．8％）、61例（41．8％）及31例（21．2％）患者残余尿试验阳性，膀胱适度充盈时分别有38例（26．0％）、31例（21．2％）、22例（15．1％）及9例（6．2％）患者残余尿试验阳性，差异均有统计学意义（P〈0．05）。结论超声测量残余尿应避免膀胱过度充盈、逼尿肌收缩功能暂时性减弱的干扰，以便准确测量残余尿，从而对膀胱出口梗阻和膀胱逼尿肌功能改变作出评价。Objective The aim of study is to evaluate whether over filling bladder volume （BV） affects the measurement of post-voiding residual urine volume （PVR）. Methods One hundred forty-six male patients with BPH were enrolled in this study between June 2015 and October 2015. Mean patients＇age was （61.8 ± 10. 1 ） years （ranging from 38 to 88 years）, Median PSA was 2.0 ng/ml （ranging from 0. 3 to 3 59. 8 ng/ml）. Median prostate volume was 31.4 cm （ranging from 20. 1 to 280. 0 cm3）. Median Qmax was 14. 0 m/s （ranging from 1.3 to 40. 4 m/s）. Measurements by transabdominal uhrasonography for BV and PVR were performed for every patient at 2 different phases, including ＂ severe＂ and ＂ mild＂ sensations of micturition. A comparison of the PVR measurements was performed. The positive cut off values were defined as 50,60,100,200ml, respectively. Results Median BV and PVR during the first and second phases were 573 ml and 72 ml, and 230 ml and 15 ml, respectively. Post-void residual urine volume with over bladder filling （PVR1） was different from that recorded after normal bladder filling and voiding at first desire （ PVR2）, which the former was larger than the later in every patient （ P 〈 0.05 ）. With 50 ml, 60 ml, 100 ml and 200 ml as the cut off value for a pathologic PVR, 88 （ 60. 3% ）, 80 （54. 8% ）, 61 （ 41.8% ） and 31（21.2%） men had positive PVR in the first phase, whereas the same rate was calculated as 26.0% （38） ,21.2% （31）,15.1% （22） and 6.2% （9） under the second phases. Conclusions Post-voiding residual urine volume measurements with an uncomfortably full bladder result in high false-positive values, which was caused by the temporary detrusor contractive insufficient. Measurement of post-void residual volume in a relaxed patient should be the correct method of testing, which can evaluate the condition of bladder outlet and detrusor accurately.

关 键 词：良性前列腺增生 残余尿 超声 

分 类 号：R445.1[医药卫生—影像医学与核医学] R697.3[医药卫生—诊断学]