逼尿肌收缩压测定在BPH患者术后疗效评估中的意义

Significance of preoperative detrusor contractility to the postoperative assessment of prostatectomy for benign prostatic hyperplasia

目的探讨逼尿肌收缩压测定在BPH患者术后疗效评估中的应用价值。方法BPH患者109例。年龄62～83岁，平均71岁。均行尿动力学检查，明确诊断BOO，排除神经、内分泌以及其他系统疾病因素。根据逼尿肌收缩情况分为2组：I组为逼尿肌亢进型61例，逼尿肌收缩压≥40cmH2O（1emH2O=0．098kPa），单纯行TURP或开放手术；1／组为逼尿肌无力型48例，逼尿肌收缩压≤20cmH2O，同期行TURP和膀胱造瘘术，术后持续开放造瘘管至少2周。统计学比较2组患者术后1、3个月逼尿肌收缩压、Qmax和残余尿等参数。结果2组患者术前最大逼尿肌收缩压分别为（78．4±37．0）、（19．2±5．4）cmH2O，Qmax分别为（7．6±2．2）、（2．5±1．1）ml／s，组问差异均有统计学意义（P〈0．05）；术后1个月Qmax分别为（17．4±2．9）、（12．5±2．0）mL／s，组间差异有统计学意义（P〈0．05）；术后3个月Qmax分别为（18．3±2．8）、（15．2±1．8）ml／s，组问差异无统计学意义（P〉0．05）。结论BPH患者BOO解除后，收缩乏力状况可以逐渐恢复，Q±能获得改善，对合并逼尿肌收缩无力患者积极手术解除梗阻，可促进逼尿肌功能恢复。

Objective To study the value of the preoperative detrusor contractility to the outcome assessment of prostatectomy for benign prostatic hyperplasia （ BPH）. Methods A total of 109 patients with BPH were analyzed. Their ages ranged from 62 to 83 years with a mean of 71 years. All patients underwent urodynamic study to confirm a diagnosis of BOO preoperatively. Further more, their BOO was not caused by nervous, endocrine or other diseases. Pateints were divided into two groups based on maximum detrusor contractility. Group I （n = 61, BPH with maximum detrusor contractility ≥40 cm H20, 1 cm H20 =0. 098 kPa） underwent TURP or open surgery, respectively. Group II （n = 48, BPH with maximum detrusor contractility ≤ 20 cm H2 O） underwent TURP and suprapubic punctural cystostomy simultaneously, the bladder fistula was kept open continuously for at least two weeks postoperatively. The difference in outcome between the two groups was assessed by using urodynamic parameters including maximum detrusor contractility, Qmax and residual urine at one and three months postoperatively respectively. Student＇s t-test was used to compare the result for normally distributed data and Wilcoxon＇s signed-ranks test for skewed data in this study. Results There was significant difference in preoperative maximum contractility, Qmax between group I and group II （78.4 ±37.0 cm H20） vs （19.2 ±5.4 cm H20）（P〈0.01）, （7. 6 ±2.2 ml/s） vs （2.5 ± 1. 1 ） ml/s （P 〈 0.05） respectively. Although there was significant difference at one month postoperatively in Qmax （17.4 ±2.9）mL/s vs （12.5±2.0）ml/s （P 〈0.05） , no significant difference was found in Qmax between the two groups after three months （18.3± 2.8 ml/s） vs （15.2 ± 1.8） ml/s （P 〉 0.05）. Conelttsions The Qmax may improve and the impaired detrusor recovered gradually after the BOO was removed. Performing an operation on patients with BOO accompanied with detrusor underactivity may be useful to recover detrusor contractility.