尿道压力描记检查在人工尿道括约肌植入术中的应用  

Application of urethral pressure profilometry in artificial urinary sphincter implantation

作　　者：孟令峰[1] 刘晓东 王淼 张威[1] 侯惠民[1] 赵爽怿 周云鹤 褚欣[1] 伍建业[1] 张耀光[1] 王晓明[2] 王建伟[3] Meng Lingfeng;Liu Xiaodong;Wang Miao;Zhang Wei;Hou Huimin;Zhao Shuangyi;Zhou Yunhe;Chu Xin;Wu Jianye;Zhang Yaoguang;Wang Xiaoming;Wang Jianwei(Department of Urology,Beijing Hospital,National Center of Gerontology/Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Urology,Second Hospital Affiliated to Tianjin Medical University,Tianjin 300010,China;Department of Urology,Beijing Jishuitan Hospital,Beijing 100096,China)

机构地区：[1]北京医院泌尿外科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]天津医科大学第二医院泌尿外科,天津300010 [3]北京积水潭医院泌尿外科,北京100096

出　　处：《中华医学杂志》2020年第26期2044-2048,共5页National Medical Journal of China

基　　金：国家重点研发计划(2018YFC2002202)。

摘　　要：目的应用尿道压力描记检查探讨人工尿道括约肌(AUS)植入术前后最大尿道压(MUP)及最大尿道闭合压(MUCP)的变化情况及预后价值。方法回顾性分析自2019年3至7月在多家医院接受AUS植入术的患者的临床资料。收集患者术前、术中尿道压力描记检查结果、尿垫使用量、相关评分及手术相关并发症出现情况,并比较其差异。研究终点是激活控制泵后1个月的控尿情况。结果共5例患者纳入研究,且均为男性。其中2例因前列腺增生接受经尿道前列腺电切术,2例因前列腺癌接受前列腺癌根治术,1例因车祸伤接受尿道会师术、尿道狭窄扩张术及膀胱造瘘术;所有患者就诊时均存在不同程度尿失禁。患者年龄61~84岁(平均72.6岁)。术前尿道压检测示5例患者的MUP分别为52、53、88、32、66 cmH2O(1 cmH2O=0.098 kPa),MUCP分别为17、52、62、27、40 cmH2O。行AUS植入术,术中尿道压检测示失活状态下MUP分别为53、113、50、77、89 cmH2O,MUCP分别为50、97、31、71、51 cmH2O;激活状态下MUP分别为112、174、193、121、120 cmH2O,MUCP分别为109、160、175、114、92 cmH2O。术后6周所有患者均成功激活控制泵,激活控制泵后1个月电话随访,所有患者均达到社交控尿(0~1块尿垫/d)标准。截至随访时未发生手术相关并发症。结论通过测量AUS植入术中MUP及MUCP的具体数值,并与控尿效果对比,可以得到术中尿道压范围与控尿效果之间的关系,从而为AUS植入术疗效评估提供数据化依据。Objective To investigate the changes of maximum urethral pressure(MUP)and maximum urethral closure pressure(MUCP)after artificial urethral sphincter(AUS)implantation and their prognostic value.Methods The clinical data of patients who had undergone AUS implantation in multiple medical centers between March and July 2019 were retrospectively analyzed.Data of urethral pressure profilometry,pad usage,related scores and complications related to surgery were collected and compared.The primary endpoint was social continence(defined as 0-1 pad/d)1 month after activation of the pump.Results A total of five male patients were included in this study.Two underwent transurethral resection of the prostate for benign prostatic hyperplasia,two underwent radical prostatectomy for prostate cancer,and one underwent urethral reunion,urethral stricture dilatation and cystostomy due to trauma from traffic accident.All patients had different degrees of urinary incontinence.The results of preoperative urethral profilometry test showed that the MUP of five patients were 52,53,88,32,and 66 cmH2O(1 cmH2O=0.098 kPa),respectively,and the MUCP were 17,52,62,27,and 40 cmH2O,respectively.AUS implantation was performed.The intraoperative urethral pressure profilometry showed that the MUP were 53,113,50,77,and 89 cmH2O in the inactivated state,and the MUCP were 50,97,31,71,and 51 cmH2O,respectively.In the activated state,the MUP were 112,174,193,121,and 120 cmH2O,and the MUCP were 109,160,175,114,and 92 cmH2O,respectively.All patients met the social continence(0-1 pad/d)criterion.No complications were reported during the follow-up.Conclusions The relationship between the range of intraoperative urethral pressure and the effect of urinary control can be gained by measuring the specific values of MUP and MUCP during AUS implantation and the post-operative effects,which provides as a data basis for standardizing AUS implantation.

关 键 词：尿失禁 尿道括约肌 人工 尿动力学 最大尿道压 最大尿道闭合压 

分 类 号：R699.6[医药卫生—泌尿科学]