子宫颈癌根治术后伴排尿异常患者膀胱功能的尿动力学研究  

Urodynamic study of bladder dysfunction after radical hysterectomy of cervical cancer

作　　者：王健健 张艳平 刘二鹏 孟庆博 姜春姿 杨兴欢 文建国[1] Wang Jianjian;Zhang Yanping;Liu Erpeng;Meng Qingbo;Jiang Chunzi;Yang Xinghuan;Wen Jianguo(Urodynamic Diagnosis and Treatment Center Henan,Department of Urology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Hepatopancreatobiliary Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科和河南省尿动力诊断治疗中心,郑州450052 [2]郑州大学第一附属医院肝胆胰外科,郑州450052

出　　处：《中华老年医学杂志》2022年第3期302-306,共5页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(81670689)。

摘　　要：目的探讨子宫颈癌根治术后伴排尿异常患者膀胱功能的尿动力学特点。方法本研究为前瞻性自身对照研究。选择2016年1月至2018年6月符合术前纳入标准且临床分期为ⅠB~ⅡA期子宫颈癌患者84例。所有纳入病例均接受子宫颈癌根治术治疗,于术前1周内、术后6个月时行尿动力学检测,观察评估手术前后患者的膀胱功能状态并分析其尿动力检查结果特点。结果所有患者中有58例患者根治术后伴排尿异常表现,26例无排尿异常表现,两种不同表现的患者之间年龄、临床分期及病理类型比较均无明显差异;其中根治术后伴排尿异常的患者术后均出现不同症状的排尿异常,包括排尿困难(55%)、尿频伴排尿不尽感(34%)、压力性尿失禁(7%)、急迫性尿失禁(4%)。根治术后无排尿异常患者中仅有1例表现为尿动力学检查异常(膀胱感觉异常),术后无排尿异常患者手术前后的尿动力检查结果比较差别均无统计学意义(均P>0.05)。在子宫颈癌根治术后伴排尿异常的病例中,43例(74%)膀胱功能障碍患者术前排尿模式正常而术后排尿异常需借助腹压。所有根治术后伴排尿异常患者术后6个月时的最大尿流率、平均尿流率、排尿量、尿流时间、达峰时间、膀胱残余尿量、最大逼尿肌收缩压、膀胱顺应性、正常尿意膀胱容量、最大膀胱容量、最大尿道压力、最大尿道闭合压和功能性尿道长度分别为(12.9±10.3)ml/s、(6.0±4.2)ml/s、(148.0±36.8)ml、(32.9±22.1)s、(11.4±5.0)s、(260.2±219.2)ml、(12.1±8.9)cm H_(2)O(1 cmH_(2)O=0.098 kPa)、(16.1±4.3)ml/cm H_(2)O、(354.5±204.3)ml、(587.4±152.5)ml、(97.6±33.1)cm H_(2)O、(89.9±36.4)cm H_(2)O、(29.6±6.5)mm;而术前1周相应各值分别为(25.1±11.4)ml/s、(11.38±6.6)ml/s、(318.6±96.4)ml、(29.2±18.5)s、(6.7±3.9)s、(29.9±21.5)ml、(31.87±21.43)cm H_(2)O、(78.1±33.9)ml/cm H_(2)O、(258.2±185.5)ml、(335.1±124.9)ml、(96.4±33.9)cm H_(Objective To explore the urodynamic characteristics of bladder function in patients with abnormal urination after radical hysterectomy of cervical cancer.Methods In a prospective self-controlled study,a total of 84 patients with cervical cancer and clinical stage ofⅠB toⅡA,meeting the preoperative inclusion criteria in our hospital from January 2016 to June 2018 were enrolled.All patients were tested for urodynamic testing 1 week before and 6 months after surgery.Patient bladder function status was observed and evaluated before and after surgery and urodynamic examination results were analyzed.Results Of 84 study cases,the 58 patients developed abnormal urination after radical surgery,there were no urination abnormalities in 26 cases.There was no significant difference in age,clinical stage and pathological diagnosis between patients with and without urination abnormalities.Abnormal urination after radical surgery included difficulty in urinating(55%),frequent urination with a feeling of urination not complete(34%),stress urinary incontinence(7%),and urinary incontinence(4%).Among the 26 patients without urination abnormalities after radical surgery,only one case showed an abnormal urodynamic examination(abnormal bladder sensation).In patients without abnormal urination after surgery,differences in the urodynamic examination findings between pre-and post-surgery were not statistically significant(all P>0.05).At the same time,in all cases of abnormal urination after radical hysterectomy of cervical cancer,43 patients(74%)with bladder dysfunction had normal urination pattern before operation,but after operation,the urination abnormality required abdominal pressure.Of the patients with bladder dysfunction after surgery,the maximum flow rate(Qmax)was(12.9±10.3)ml/s,the average flow rate(Qave)was(6.0±4.2)ml/s,the voided volume was(148.0±36.8)ml,voiding time was(32.9±22.1)s,maximum flow time was(11.4±5.0)s,postvoid residual urine was(260.2±219.2)ml,maximal detrusor pressure was(12.1±8.9)cmH_(2)O,bladder comp

关 键 词：子宫颈癌 膀胱 尿动力学 

分 类 号：R737.33[医药卫生—肿瘤]