Ⅲ型子宫切除术对患者下尿路功能的影响及其机制研究

Effects of type Ⅲ hysterectomy on lower urinary tract function

目的：通过对Ⅲ型子宫切除手术前后患者尿流动力学指标数据的分析对比，评估术后患者下尿路功能改变情况，探寻其发生机制、主要影响因素和变化趋势。方法：选取Ⅲ型子宫切除手术患者，于术前后12—14d和术后3个月分别对患者行尿流动力学检查，分析患者手术前后的尿动力学参数。结果：Ⅲ型子宫切除术后12～14d残余尿量、尿流时间、排尿感容量和最大膀胱压较术前明显增加（P〈0．05）；最大尿流率、平均尿流率、排尿量、膀胱容量、顺应性、逼尿肌压力、最大尿道压和最大尿道闭合压较术前明显下降（P〈0．05）。术后3个月残余尿量、尿流时间、排尿感容量和最大膀胱压较术前增加（P〈0．05）；而最大尿流率、逼尿肌压力、顺应性、最大尿道压和最大尿道闭合压则下降（P〈0．05）。术后3个月与12～14d相比最大尿流率、平均尿流率、排尿量、膀胱容量、顺应性和逼尿肌压力明显增加（P〈0．05），残余尿量和最大膀胱压明显减小（P〈0．05）。结论：I!I型子宫切除术后12—14d多数患者出现明显的下尿路功能障碍：膀胱顺应性急剧减小所致储尿功能异常、逼尿肌无收缩力导致排尿功能障碍和尿道闭合压降低引起控尿功能下降。膀胱储尿、排尿功能术后3个月有所恢复，但没有恢复到术前状态。

AIM： To analyze the urodynamic data and assess the alterations of lower urinary tract function in the patients before and after radical hysterectomy （ type III）. METHODS ： The patients who underwent type III hysterecto- my without complications and other diseases were enrolled in the study. Urodynamic examination was performed in the pa- tients before operation and 12 - 14 d after surgery. The examination was carried out again 3 months post-operation. REo SULTS： Post-void residual （PVR）, flow time （FT）, first desire to void volume （FDV） and maximum vesical pressure （ Pvesmax ） were increased in the patients 12 - 14 d after operation. Maximum flow rate （ Qmax ）, average flow rate （ Qave ）, voided volume （ VV）, maximum cystometric capacity （ MCC ）, bladder compliance （ BC）, detrusor pressure （ Pdet）, maximum urethral pressure （MUP） and maximum urethral closure pressure （MUCP） were significantly decreased com- pared with preoperative data （P 〈 0. 05）. PVR, FT, FDV and Pvesmx in 3 months post-hysterectomy were increased, and Qm,x, Pdet, BC, MUP and MUCP were decreased compared with preoperative data （P 〈 0. 05）. Qmax, Q vv, MCC, BC and Pdet in 3 months post-hysterectomy increased significantly, while PVR and Pvemax= were decreased compared with the data 12- 14 d after operation （P 〈 0. 05）. CONCLUSION： Most of the patients with type III hysterectomy show se- vere lower urinary tract dysfunction 12 - 14 d after operation, such as bladder storage dysfunction due to sharply decrease in bladder compliance, voiding function decline caused by deletion of detrusor contractility, and low urinary continence caused by decrease in urethral closure pressure. The bladder storage and voiding function can partially recover in 3 months.