盆腔器官脱垂患者尿动力学检查特点分析  

Urodynamics characteristics of pelvic organ prolapse

作　　者：奈嫚嫚[1] 金玉茜 李岩阁 李蕾[1] 刘琰[1] 王鲁文 NAI Manman;JIN Yuxi;LI Yange;LI Lei;LIU Yan;WANG Luwen(Department of Pelvic Floor Reconstruction,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院盆底重建科,郑州450052

出　　处：《中华实用诊断与治疗杂志》2020年第11期1125-1128,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关联合共建项目(2018020170)。

摘　　要：目的探讨盆腔器官脱垂(pelvic organ prolapse,POP)患者膀胱顺应性、膀胱容量、平均尿流率、最大尿流率(maximum flow rate,Qmax)、最大尿流率时逼尿肌压力(Pdet-Qmax)、腹压漏尿点压、排尿时间、达峰时间等尿动力学参数水平变化及临床意义。方法177例POP患者,均行尿动力学检查。将177例患者依据POP分度(POP quantitation,POP-Q)分为Ⅰ度组54例,Ⅱ度组28例,Ⅲ度组61例,Ⅳ度组34例,比较4组尿动力学参数差异。结果4组膀胱顺应性、Pdet-Qmax、腹压漏尿点压、排尿时间、达峰时间比较差异均无统计学意义(P>0.05)。Ⅲ、Ⅳ度组尿流率[(9.85±4.12)、(9.45±3.10)mL/s]低于Ⅰ、Ⅱ度组[(11.85±4.45)、(11.89±3.89)mL/s],Qmax[(24.07±9.49)、(24.56±7.76)mL/s]低于Ⅰ度组[(28.13±9.68)mL/s],膀胱容量[(440.48±127.33)、(444.03±121.38)mL]小于Ⅰ度组[(515.28±136.69)mL],达峰时间[(9.49±4.65)、(10.05±5.31)s]短于Ⅰ度组[(13.10±11.68)s](P<0.05)。177例POP患者中压力性尿失禁+混合性尿失禁85例,压力性尿失禁+膀胱出口梗阻19例,膀胱出口梗阻20例,逼尿肌收缩乏力+逼尿肌过度活动9例;Ⅰ、Ⅱ度组以压力性尿失禁+混合性尿失禁多见,Ⅲ、Ⅳ度组以膀胱出口梗阻、逼尿肌收缩乏力+逼尿肌过度活动多见。结论POP-Q分度Ⅲ、Ⅳ度POP患者平均尿流率、Qmax减慢,膀胱容量减小,逼尿肌异常比率增高。Objective To investigate the changes of urodynamic parameters,as bladder compliance,maximum cystometric capacity,average urinary flow rate,maximum flow rate(Qmax),Pdet-Qmax,abdominal leak point pressure,urination time and time to peak in patients with pelvic organ prolapse(POP)and their clinical significances.Methods Totally 177patients with POP received urodynamic examination and were divided into POP quantitation(POP-Q)Ⅰgroup(n=54),POP-QⅡgroup(n=28),POP-QⅢgroup(n=61)and POP-QⅣgroup(n=34)according to POP-Q degree.The urodynamic parameters were compared among four groups.Results There were no significant differences in bladder compliance,Pdet-Qmax,abdominal leak point pressure,urination time and time to peak among four groups(P>0.05).The average urinary flow rate was slower in POP-QⅢgroup((9.85±4.12)mL/s)and POP-QⅣgroup((9.45±3.10)mL/s)than that in POP-QⅠgroup((11.85±4.45)mL/s)and POP-QⅡgroup((11.89±3.89)mL/s),Qmax was slower in POP-QⅢgroup((24.07±9.49)mL/s)and POP-QⅣgroup((24.56±7.76)mL/s)than that in POP-QⅠgroup((28.13±9.68)mL/s),maximum cystometric capacity was smaller in POP-QⅢgroup((440.48±127.33)mL)and POP-QⅣgroup((444.03±121.38)mL)than that in POP-QⅠgroup((515.28±136.69)mL),and time to peak was shorter in POP-Ⅲgroup((9.49±4.65)s)and POP-QⅣgroup((10.05±5.31)s)than that in POP-QⅠgroup((13.10±11.68)s)(P<0.05).Among 177POP patients,there were stress urinary incontinence+mixed urinary incontinence in 85patients,stress urinary incontinence+bladder outlet obstruction in 19,bladder outlet obstruction in 20,and detrusor weakness+detrusor overactivity in 9.Stress urinary incontinence+mixed urinary incontinence occurred more commonly in POP-QⅠandⅡgroups,while bladder outlet obstruction and detrusor weakness+detrusor overactivity occurred more commonly in POP-QⅢandⅣgroups.Conclusion The average urinary flow rate and Qmax are slow,maximum cystometric capacity reduces,and the rate of abnormal detrusor muscles increases in patients with POP-QⅢandⅣ.

关 键 词：盆腔器官脱垂 尿动力学检查 压力性尿失禁 膀胱出口梗阻 逼尿肌异常 

分 类 号：R711[医药卫生—妇产科学]