宫颈癌根治术后近期膀胱功能的尿动力学分析

Urodynamic analysis of recent bladder function following radical hysterectomy

目的：探讨广泛全子宫切除术后患者近期膀胱功能的变化及其意义。方法：63例ⅠB1~ⅡA期宫颈癌患者在宫颈癌根治术前及术后接受尿动力学检测,包括充盈性膀胱测压、压力流率同步测定和括约肌肌电图检查。结果：宫颈癌根治术后近期膀胱初感容量和残余尿量均较术前明显增加（P〈0.01）,最大膀胱容量、顺应性、最大尿流率及最大尿流率时的逼尿肌压力均较术前明显降低（P〈0.01）。术后,34例患者（54.0%）尿动力学检测发现存在近期膀胱功能障碍,包括逼尿肌受损、低顺应性膀胱、膀胱流出道梗阻、逼尿肌外括约肌协同失调及逼尿肌过度活动,其中低顺应性膀胱和逼尿肌受损发生率明显高于术前（P〈0.01）。18例患者（28.6%）发生术后尿潴留,尿潴留患者的逼尿肌受损发生率（66.7%）和逼尿肌过度活动发生率（33.3%）均明显高于非尿潴留患者（分别为20.0%和4.4%）。结论：宫颈癌根治术后患者近期膀胱功能改变明显,可表现为多种类型的膀胱功能障碍,并以低顺应性膀胱和逼尿肌受损为主,而逼尿肌受损可能是导致术后尿潴留的主要原因。尿动力学检查对于术后膀胱功能障碍的病因分析及指导治疗具有重要意义。

Objective：To study the variation of recent bladder function of the patients who received radical hysterectomy and evaluate its significance.Methods：Sixty-three patients with cervical carcinoma in International Federation of Gynecology and Obstetrics（FIGO） stage IB1 to ⅡA received urodynamic examination before and after operation.The urodynamic parameters included filling cystometry,pressure-flow rate,and electromyography of sphinctienter.Results：Radical hysterectomy induced significant increase in the first sensation（P〈0.01）and post voiding residual of bladder（P〈0.01）;whereas caused significant decrease in the maximum volume（P〈0.01）,compliance（P〈0.01）,maximum flow rate（P〈0.01） and the pressure at the maximum flow rate（P〈0.01）,respectively,compared with the corresponding values before the operation.Short-term bladder dysfunctions were observed in 34 patients（54.0%） including bladder detrusor dysfunction,low compliance bladder,bladder outlet obstruction,dyssynergia of urethral external sphincter and detrusor overactivity.The incidences of low compliance bladder and bladder detrusor dysfunction increased significantly after operation（P〈0.01）.Urinary retention was found in 28.6%（18/63） patients.The incidences of bladder detrusor dysfunction（66.7% vs 20.0%） and detrusor overactivity（33.3% vs 4.4%） in the group with urinary retention were significantly higher than those of corresponding group without urinary retention.Conclusion：The bladder function had obvious short-term changes following radical hysterectomy.In the many types of bladder dysfunction the main dysfunctions were low compliance bladder and bladder detrusor dysfunction.The bladder detrusor dysfunction might be the major cause of the urinary retention following the surgery.Urodynamic test was important for post-operative analysis and treatment of bladder dysfunction.