伴有难治性储尿期LUTS女性膀胱黏膜白斑患者的影像尿动力学变化及手术疗效研究

Investigation of the video urodynamic evaluation and the effects of transurethral electro-resection of bladder mucous for the women with vesical leukoplakia and refractory storage symptoms

目的:探讨伴有难治性储尿期下尿路症状(LUTS)女性膀胱黏膜白斑患者影像尿动力学变化及手术疗效。方法:选取49例伴有非神经源性难治性储尿期LUTS并确诊为膀胱黏膜白斑的女性患者为病例组,行经尿道膀胱黏膜病变电切术,术前行影像尿动力学检查,记录排尿日记、生活质量评分(QOL);术后3个月门诊随访排尿日记、QOL等并评估手术疗效。同时选取15例仅存在上尿路疾患而下尿路功能正常的女性患者为对照组,记录排尿日记,行影像尿动力学检查。结果:病例组术前充盈期膀胱呈卵圆形或圆形,壁光滑,未见膀胱颈口开放和明显漏尿;排尿期膀胱颈口开放良好、尿道显影正常,未见逼尿肌括约肌协同失调和膀胱输尿管反流等。病例组术前正常尿意容量(VND)、功能性膀胱容量(FBC)、最大膀胱测压容量(MCC)均显著低于对照组[分别为(242±46)ml vs.(344±55)ml、(298±53)ml vs.(450±51)ml、(456±59)ml vs.(524±54)ml,P<0.01]。病例组术后的24小时排尿次数和QOL均显著低于术前[分别为(10±1)次/d vs.(14±2)次/d,(3±1)分vs.(5±1)分,P<0.01)];术后FBC显著高于术前[(447±56)ml vs.(298±53)ml,P<0.01)],与对照组FBC相比差异无统计学意义[(447±56)ml vs.(450±51)ml,P>0.05)]。病例组术后的总体手术有效率为85.7%。结论:伴有难治性储尿期LUTS女性膀胱黏膜白斑患者多伴有膀胱感觉敏感,尿动力学检查可为其诊疗提供客观依据。部分患者行经尿道膀胱黏膜病变电切术可获得满意疗效。

Objective：To investigate the video urodynamic abnormalities of women with vesical leukoplakia and refractory storage symptoms,and evaluate the surgical effects.Method：Forty-nine females who had been diagnosed with vesical leukoplakia and refractory storage symptoms formed the case group,and they underwent video urodynamic test,voiding diary and Quality of Life score（QOL）before transurethral electro-resection of bladder mucosa（TURBM）.Then,voiding diary,QOL were evaluated again three months postoperatively.Simultaneously,other 15 females without LUTS as a control group also underwent video urodynamic test and voiding diary.Result：In the case group before TURBM,their bladders were round or orbicular-ovate,and the walls of the bladders were smooth and there was no open vesical neck or leakage urine in filling stage.and when it was voiding stage,the vesical necks were open and the development of urethra were normal without detrusor-sphincter dyssynergia or vesicoureteral reflux.Volume at normal desire（VND）,functional bladder capacity（FBC）and maximal cystometric capacity（MCC）in the case group before TURBM were significantly lower than those in the control group [VND（242±46）ml vs.（344±55）ml,FBC（298±53）ml vs.（450±51）ml,MCC（456±59）ml vs.（524±54）ml,P〈0.01].The frequency and QOL in the case group after TURBM were significantly lower than those before the operation[frequency（10±1）times a day vs.（14±2）times a day,the point of QOL（3±1）vs.（5±1）,P〈0.01],and FBC in the group after the operation was higher[（447±56）ml vs.（298±53）ml,P〈0.01].However,the difference of FBC between the case group after TURBM and the control group was nonsignificant[（447±56）ml vs.（450±51）ml,P〈0.05].The effective rate of the TURBM was 85.7%.Conclusion：The women with vesical leukoplakia and refractory storage symptoms have higher sensitivities,and urodynamic studies may help to provide more scientific guidence of the diagnoses.For part of the patients,TURBM is a safe and effective method to treat the disease.