宫颈癌术后近期排尿障碍患者尿动力学分析的意义

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

目的探讨宫颈癌根治术后近期非感染性排尿障碍患者的尿动力学改变及意义。方法术前尿动力学检查止常、行广泛全子宫切除术治疗的宫颈癌患者96例作为研究对象，对其中术后尿常规榆查正常的83例患者进行术后尿动力学检查，分析引起术后非感染性排尿障碍的原因。结果无尿路感染的83例患者中，42例患者存在术后非感染性排尿功能障碍，41例无排尿功能障碍。排尿障得组患者术后膀胱最大容量为（309．84±67．53）ml，顺应性为（26．20±19．05）ml／cmH2O，最大尿流率为（10．81±4．07）mL／s，最大尿流率时逼尿肌雎力为（32．87±6．12）cmH，0，无排尿障碍组分别为（318．59±74．40）ml、（36．47±19．76）ml／cm，0、（12．93±4．89）ml／s和（32．87±6．12）emH，0，排尿障碍组的顺应性、最大尿流率和最大尿流率时逼尿肌压力均低于无排尿障碍组（均P〈0．05）。排尿障碍组低顺应性膀胱、逼尿肌受损、逼尿肌过度活动的发生率分别为50．O％、58．4％和31．0％，均明显高于无排尿障碍组（分别为17．1％、14．6％和4．9％，均P〈0．01）。按临床症状分组，单纯梗阻性症状组患者膀胱逼尿肌受损的发生率（78．9％）明显高于单纯刺激性症状组（27．3％），而单纯刺激性症状组患者逼尿肌过度活动的发生率（63．6％）明显高于单纯梗阻性症状组（21．1％）和混合性症状组（16．7％，均P〈0．05）。结论术后近期非感染性排尿障碍的患者存在多种类型的尿动力学异常，盆腔自主神经受损引起的低顺应性膀胱、逼尿肌受损以及逼尿肌过度活动町能是其发生的主要原因。其中，逼尿肌受损以及过度活动可能是引起术后梗阻性症状及刺激性症状的关键因素。尿动力学检查对指导术后近期非感染性排尿障碍的病因分析及临床治疗，具有重要意义。

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