盆腔脂肪增多症的尿动力学特点及临床意义

Pelvic lipomatosis： urodynamic characters and clinical significance

目的探讨盆腔脂肪增多症（pelvic lipomatosis，PL）患者的尿动力学特点及临床意义。方法回顾性分析2013年9月至2016年2月我院收治的7例PL患者的临床资料。男6例，女1例。年龄39～54岁，平均46岁。7例患者纳入研究组，均因下尿路症状就诊，经影像学检查诊断为PL。7例均未进展至肾功能不全，其中4例合并肾积水。选取同时间段因相似下尿路症状就诊、影像学及尿动力学检查正常者7例，按相同性别比例配对纳入对照组。比较两组患者的尿流动力学检查数据：尿流率、达峰时间、残余尿量、初感觉容量、尿意容量、膀胱容量、顺应性、膀胱内压、最大尿流率时逼尿肌压、逼尿肌开放压、梗阻指数及收缩指数等的差异。结果研究组和对照组的最大尿流率分别为（18．71±10．31）ml／min和（13．29±6．55）ml／min；达峰时间分别为（6．71±2．50）s和（7．43±2．76）s；残余尿量分别为（28．14±27．81）ml和（3．14±3．48）ml；初感觉容量分别为（138．86±77．01）ml和（142．29±89．84）ml；尿意容量分别为（203．71±131．09）ml和（216．57±72．20）ml；膀胱容量分别为（271．0±151．95）ml和（323．29±92．87）ml；膀胱内压分别为（30．29±16．45）cmH2O（1cmH，0=0．098kPa）和（18．71±9．57）cmH2O；顺应性分别为（90．53±126．46）cmH20／ml和（129．57±136．25）cmH2O／ml，上述指标组间比较差异均无统计学意义（均P〉0．05）。研究组和对照组的最大尿流率时逼尿肌压分别为（69．57±25．06）cmH2O和（33．14±11．63）cmH2O；逼尿肌开放压分别为（42．57±22．16）cmH2O和（18．00±13．18）cmH2O；梗阻指数分别为（34．00±15．92）和（16．50±5．96）；收缩指数分别为（133．17±27．37）和（87．67±20．16），组间比较差异均有统计学意义（均P〈0．05）。研究组中PL合并肾积水者和未合并肾积水者的收缩指数分别为（155．67±14．98）和（110．67±11．37），差异有统计学意义（P〈0．05）。结论尿流动力学检查结果提示PL患者表现为最大逼尿肌压力及逼尿肌开放压力升高等梗阻相关变化。

Objective To study the urodynamic characters of pelvic lipomatosis（PL） and its clinic significance. Methods From Sep. 2013 to Feb. 2016, 7 patients, including 6 males and one female, were diagnosed as PL by image examinations and related lower urinary tract syndrome. Their mean age was 46 years, ranged from 30 to 52 years. All the patients（ study group） have normal renal function. However,4 patients were noticed bilateral hydronephrosis. Other patients with similar LUTS but were confirmed as normal by image and urodynamic examinations were concluded in control group, which was paired designed to match the study group in visiting time, gender, age, and number of patients. The uroflowmetry and pressure/flow cystometry were performed in all patients. The urodynamic data of two groups including maximum flow rate （Qmax）, time to maximum flow, post-voiding residual （PVR） , first sensation capacity, first desire to void capacity, cystometric capacity, intravesical pressure at terminal of filling phase, compliance, detrusor pressure at maximum flow, detrusor opening pressure, bladder outlet obstruction index （BOOI） and bladder contractility index （BCI）, were retrospectively analyized. Results There were no significant different between study and control groups respect to Qmax [ （ 18.71 ± 10.31 ） ml/miu vs. （ 13.29 ± 6.55 ） ml/min], time to maximum flow [（6.71 ±2.50）s vs. （7.43 ±2.76）s], PVR [（28.14 ±27.81）ml vs. （3.14± 3.48）ml], first sensation capacity[ （ 138.86 ±77.01 ） ml vs. （ 142.29 ± 89.84） ml], first desire to void capacity [ （ 203.71 ± 131.09 ） ml vs. （ 216.57 ± 72.20 ） ml ] , cystometric capacity [ （ 271.0 ± 151.95 ） ml vs. （ 323.29 ± 92.87） ml], intravesical pressure at terminal of filling phase [ （ 30.29 ± 16.45 ） cmH2O vs. （ 18.71 ± 9.57 ） cmH2O ], and compliance [ （ 90.53 ± 126.46 ） cmH2O/ml vs. （ 129.57 ± 136.25 ） cmH2O/ ml ]. The study group was significant higher than control group in terms of pressure at maximum flow [ （ 69. 57 ±25.06） cmH20 vs. （33. 14 ± 11.63） cmH20, P = 0. 004], opening pressure , （42.57 ± 22. 16） cmH20 vs. （18.00 ± 13.18） cmH2O,P =0.027], BOOI [ （34.00 ± 15.92） vs. （16.50± 5.96） ,P = 0. 030 ] and BCI [ （133.17 ±27.37） vs. （87.67 ±20.16） ,P =0. 008] ,respectively. Moreover, the BCI of PL patients with hydronephrosis were significant higher compare with PL patients without hydronephrosis E （ 155.67 ± 14.98） vs. （ 110.67 ± 11.37 ）, P = O. 014 ]. Conclusions The urodynamic characters of PL were increased pressure at maximum flow and opening pressure, which implied obstruction.