同步膀胱膜部尿道测压的临床意义

The clinical value of membranous urethro-cystometry

目的 探讨同步膀胱膜部尿道压力测定的临床意义。 方法 采用DantecDuet尿动力学仪同步测定 412例泌尿系病人和 6例健康者充盈和排尿时的膀胱和膜部尿道压力 ,肌电图用直肠电极测定。 结果 (1)健康人充盈期膜部尿道压 ,男性为 40～ 5 0cmH2 O ,女性为 2 0～ 30cmH2 O ,充盈期膜部尿道压高于膀胱压 ,且全充盈期没有明显变化 ,排尿时膜部尿道压力明显下降低于膀胱压。 (2 )逼尿肌尿道协同失调的病人 ,排尿时膜部尿道压升高 ,其中逼尿肌外括约肌协同失调 (DEDS)时合并有肌电活动明显增加 ,逼尿肌膀胱颈协同失调 (DBDS)肌电活动正常 ,排尿期尿道测压膀胱颈处压力呈斜坡样下降。 (3)尿道关闭机制下降或不全时充盈期膜部尿道压明显低 ,且充盈期膜部尿道膀胱压力差为负值。 (4 )尿道不稳定时充盈期膜部尿道压突然下降且幅度≥ 15cmH2 O。 (5 )正常尿道腹压传递率为 2 0 %～ 35 % ,而压力性尿失禁 (GUI)病人尿道腹压传递率 <2 0 %。 结论 同步膀胱膜部尿道压力测定操作简单 ,在判断尿道关闭机制的正常与否、逼尿肌尿道的协同与否、尿道稳定性及腹压向尿道的传递效率方面有重要价值。

Objective To evaluate the clinical value of membranous urethro-cystometry. Methods Membranous urethro-cystometry by the use of Dantec Duet Urodynamic Instrument was carried out in 412 urological cases and in 6 normal subjects (3 male and 3 female). Results In the normal males ,the membranous urethral pressure at filling phase was 40～50 cmH 2O,being 20～30 cmH 2O in normal females.Both the two were higher than the bladder pressure.On voiding,the membranous urethral pressure declined below the bladder pressure.In detrusor-urethral dyssynergia,the membranous urethral pressure elevated on voiding.When there was detrusor-external sphincter dyssynergia,it was further complicated by electric overactivity.In detrusor-bladder neck dyssynergia,the bladder neck pressure sloped down at voiding.When there was urethral closure dysfunction,membranous urethral pressure declined markedly and became lower than the bladder pressure.In unstable urethra,membranous urethra pressure dropped suddenly more than 15 cmH 2O.The normal abdominal pressure transfer rate to urethra was 20%～35%.Whereas,in GSI patients,the transfer rate declined to lower than 20% Conclusions Membranous urethro-cystometry is simple,reproducible with important clinical value.