压力流率测定在女性膀胱流出道梗阻诊断中的应用研究

Application of pressure-flow study to diagnosis of female bladder outlet obstruction

目的探讨压力流率测定(pressure-flowstudy,PF-S)在女性膀胱流出道梗阻(femalebladderoutletobstruc-tion,FBOO)诊断中的价值。方法随访我科收治的经尿道膀胱颈切开术治疗的FBOO患者54例,将手术治疗有效和效果显著作为反证术前FBOO诊断准确无误的依据,并将这部分患者组成FBOO组,以29例正常女性为对照,采用ROC曲线分析,评价PF-S的诊断价值。结果PF-S指标的ROC曲线下面积(areaundercurve,AUC)、诊断阈值为及其敏感性(SEN)和特异性(SPE)分别为:最大尿流率(Qmax):AUC=0.823、Qmax≤15ml/s(SEN=87%,SPE=81%);最大尿流率时逼尿肌压(PdetQmax):AUC=0.826、PdetQmax≥28.5cmH2O(SEN=76%,SPE=72%);A-G数:AUC=0.922、A-G数≥1.1(SEN=86%,SPE=86%)。结论女性患者PF-S指标为Qmax≤15ml/s,PdetQmax≥28.5cmH2O以及A-G数≥1.1时膀胱流出道梗阻可能性大。

Objective To investigate the value of urodynamic parameters in diagnosing female bladder outlet obstruction. Methods By follow-up investigation, 36 out of 54 patients who underwent transurethral vesical neck incision for female bladder outlet obstruction （FBOO） were proven to achieve good therapeutic efficacy, so the clinical diagnosis as FBOO made before treatment was regarded as correct, as FBOO group. Anther 29 asymptomatic healthy female subjects were selected as controls. ROC curve was used to analyze the urody- namic parameters. Results The area under curve, cutoff for diagnosis and their sensitivity and specificity of the parameters were as follows： Q max： AUC=0.823, Qmax ≤15 ml/s （SEN=87%, SPE=81%）; PdetQmax ： AUC =0. 826, PdetQmax≥28.5 cmH2O （SEN =76% , SPE =72% ） ; A-G value： AUC =0. 922, A-G value ≥ 1.1 （SEN =86%, SPE =86% ）. Conclusion When Qmax ≤15 ml/s, PdetQmax ≥28.5 cmH2O and A-G value ≥ 1.1, FBOO is likely to occur in female.