逼尿肌-尿道外括约肌协同失调患者的压力-流率-EMG测定

Pressure flow EMG study in patients with detrusor external sphincter dyssynergia

为探讨逼尿肌尿道外括约肌协同失调（ＤＥＳＤ）患者的压力流率ＥＭＧ测定的意义，对３３例ＤＥＳＤ患者进行排尿期压力、流率及尿道外括约肌ＥＭＧ测定。各型特点为：Ⅰ型ＤＥＳＤ出现于逼尿肌收缩开始，随逼尿肌压力上升，ＥＭＧ活动正常或增强，外括约肌突然开放，ＥＭＧ活动消失，尿液排出；Ｐｄｅｔｏｐｅｎ明显增高，高于ＰｄｅｔＭＦ，Ｐｄｅｔｅｎｄ较低。Ⅱ型ＤＥＳＤ间歇性发生于排尿过程中，逼尿肌及外括约肌同时收缩、松弛交替出现，ＥＭＧ活动相应增强、减弱，产生间歇性排尿；尿流率与逼尿肌压力曲线呈双曲线波浪型交替改变，Ｐｄｅｔｏｐｅｎ增高不如Ⅰ型明显，Ｐｄｅｔｅｎｄ较高。Ⅲ型ＤＥＳＤ持续整个排尿过程，外括约肌持续收缩，ＥＭＧ活动持续增强，无尿液排出；逼尿肌压力曲线呈高水平延伸或单曲线波浪型，Ｐｄｅｔ较高。结果认为：压力流率ＥＭＧ测定可为临床诊断和鉴别诊断ＤＥＳＤ提供可靠手段。

Pressure flow EMG studies were carried out in 33 cases of detrusor external sphincter dyssynergia (DESD), 28 suprasacral dysfunction and 5 diabetic cystopathy (infra sacral lesions). According to the P F manifestations, DESD could be divided into 3 types∶ the beginning type (Ⅰ),the intermittent type (Ⅱ) and the sustained type (Ⅲ). The chacrateristics of type Ⅰ DESD were as follows ∶ the detrusor and the urethral external sphyincter (UES) contracted at the beginning of micturation and then relaxed suddenly and the passage of urine was allowed;P G plot showed a higher Pdet open, a low Pdet MF and Pdet end. In type Ⅱ DESD, the detrusor contraction was followed by a contraction of the pelvic floor muscles and on subsequent detrusor and UES relaxation a small amount of urine passage was allowed; P Q plot showed a higher Pdet end. In type Ⅲ,UES continued to contract and EMG activities increased during the detrusor contraction with no urine flow at all; P Q plot showed a higher Pdet. P F EMG studies might also unable us to distinguish DESD from detrusor areflexia(DAF). P F EMG studies was claimed to be reliable in the diagnosis and differential diagnosis of DESD.