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[尿动力学分析在根治性子宫切除术后近期排尿功能障碍患者中的意义]

[Significance of urodynamic analysis in the patients with recent voiding dysfunction after radical hysterectomy].

作者信息

Chen Xian-jing, Song Yi-yi, DU Kai-hong, Yu Jin, Li Ying, Lin Chao-qin

机构信息

Department of Gynecology, Fujian Provincial Maternity and Child Health Hospital, Fuzhou, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2012 Jan;34(1):35-8.

Abstract

OBJECTIVE

To study the urodynamic changes in patients with recent non-infective voiding dysfunction following radical hysterectomy and assess its significance.

METHODS

Ninety-six patients with cervical cancer, who were not found any abnormal representation of urodynamics before the operation, were selected into this study group. Eighty-three patients in the study group without urinary infection were detected by urodynamic examination following radical hysterectomy, in order to analyze the urodynamic reasons for the non-infective voiding dysfunction following the surgery.

RESULTS

Forty-two patients were found with non-infective voiding dysfunction after the operation. Low compliance bladder, bladder destrusor dysfunction and destrusor overactivity were the three leading types of postoperative bladder dysfunction. Moreover, the incidences of low compliance bladder (50.0% vs. 17.1%), bladder destrusor dysfunction (58.4% vs. 14.6%) and destrusor overactivity (31.0% vs. 4.9%) in the group with voiding dysfunction were significantly higher than the corresponding values in the group without voiding dysfunction (P < 0.01). Secondarily, forty-two patients with recent non-infective voiding dysfunction were divided into simple irritation sign group, simple obstruction sign group and mixed sign group according to their main symptoms. The incidence of bladder destrusor dysfunction in the simple obstruction sign group was significant higher than that in the simple irritation sign group, and the incidence of detrusor overactivity in the simple irritation sign group was significant higher than that in the other two groups (P < 0.05).

CONCLUSIONS

There were many different types of urodynamic disorder in the patients with recent non-infective voiding dysfunction after radical hysterectomy. Low compliance bladder, bladder destrusor dysfunction and detrusor overactivity caused by the damage of the pelvic autonomic nerve during the operation may be the main reasons for the recent non-infective voiding dusfunction after radical hysterectomy. Moreover, bladder destrusor dysfunction and detrusor overactivity may be the key points for the symptoms of bladder irritation and bladder obstruction. Urodynamic study is important for the etiology analysis and clinical treatment of recent non-infective voiding dysfunction postoperation.

摘要

目的

研究根治性子宫切除术后近期非感染性排尿功能障碍患者的尿动力学变化并评估其意义。

方法

选取96例宫颈癌患者,这些患者术前尿动力学检查未发现任何异常表现,纳入本研究组。研究组中83例无泌尿系统感染的患者在根治性子宫切除术后接受尿动力学检查,以分析术后非感染性排尿功能障碍的尿动力学原因。

结果

术后发现42例患者存在非感染性排尿功能障碍。膀胱顺应性降低、膀胱逼尿肌功能障碍和逼尿肌过度活动是术后膀胱功能障碍的三种主要类型。此外,排尿功能障碍组膀胱顺应性降低(50.0%对17.1%)、膀胱逼尿肌功能障碍(58.4%对14.6%)和逼尿肌过度活动(31.0%对4.9%)的发生率显著高于无排尿功能障碍组的相应值(P<0.01)。其次,将42例近期非感染性排尿功能障碍患者根据其主要症状分为单纯刺激征组、单纯梗阻征组和混合征组。单纯梗阻征组膀胱逼尿肌功能障碍的发生率显著高于单纯刺激征组,单纯刺激征组逼尿肌过度活动的发生率显著高于其他两组(P<0.05)。

结论

根治性子宫切除术后近期非感染性排尿功能障碍患者存在多种不同类型的尿动力学紊乱。手术中盆腔自主神经损伤导致的膀胱顺应性降低、膀胱逼尿肌功能障碍和逼尿肌过度活动可能是根治性子宫切除术后近期非感染性排尿功能障碍的主要原因。此外,膀胱逼尿肌功能障碍和逼尿肌过度活动可能是膀胱刺激症状和膀胱梗阻症状的关键因素。尿动力学研究对术后近期非感染性排尿功能障碍的病因分析和临床治疗具有重要意义。

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