子宫颈癌根治术后伴排尿异常患者膀胱功能的尿动力学研究

Urodynamic study of bladder dysfunction after radical hysterectomy of cervical cancer

目的探讨子宫颈癌根治术后伴排尿异常患者膀胱功能的尿动力学特点。方法本研究为前瞻性自身对照研究。选择2016年1月至2018年6月符合术前纳入标准且临床分期为ⅠB~ⅡA期子宫颈癌患者84例。所有纳入病例均接受子宫颈癌根治术治疗,于术前1周内、术后6个月时行尿动力学检测,观察评估手术前后患者的膀胱功能状态并分析其尿动力检查结果特点。结果所有患者中有58例患者根治术后伴排尿异常表现,26例无排尿异常表现,两种不同表现的患者之间年龄、临床分期及病理类型比较均无明显差异;其中根治术后伴排尿异常的患者术后均出现不同症状的排尿异常,包括排尿困难(55%)、尿频伴排尿不尽感(34%)、压力性尿失禁(7%)、急迫性尿失禁(4%)。根治术后无排尿异常患者中仅有1例表现为尿动力学检查异常(膀胱感觉异常),术后无排尿异常患者手术前后的尿动力检查结果比较差别均无统计学意义(均P>0.05)。在子宫颈癌根治术后伴排尿异常的病例中,43例(74%)膀胱功能障碍患者术前排尿模式正常而术后排尿异常需借助腹压。所有根治术后伴排尿异常患者术后6个月时的最大尿流率、平均尿流率、排尿量、尿流时间、达峰时间、膀胱残余尿量、最大逼尿肌收缩压、膀胱顺应性、正常尿意膀胱容量、最大膀胱容量、最大尿道压力、最大尿道闭合压和功能性尿道长度分别为(12.9±10.3)ml/s、(6.0±4.2)ml/s、(148.0±36.8)ml、(32.9±22.1)s、(11.4±5.0)s、(260.2±219.2)ml、(12.1±8.9)cm H_(2)O(1 cmH_(2)O=0.098 kPa)、(16.1±4.3)ml/cm H_(2)O、(354.5±204.3)ml、(587.4±152.5)ml、(97.6±33.1)cm H_(2)O、(89.9±36.4)cm H_(2)O、(29.6±6.5)mm;而术前1周相应各值分别为(25.1±11.4)ml/s、(11.38±6.6)ml/s、(318.6±96.4)ml、(29.2±18.5)s、(6.7±3.9)s、(29.9±21.5)ml、(31.87±21.43)cm H_(2)O、(78.1±33.9)ml/cm H_(2)O、(258.2±185.5)ml、(335.1±124.9)ml、(96.4±33.9)cm H_(2)O、(88.5±35.2)cm H_(2)O、(37.16±7.24)mm。子宫颈癌根治术后伴排尿异常患者最大尿流率、平均尿流率、排尿量、最大逼尿肌收缩压、膀胱顺应性、功能性尿道长度明显低于术前,而正常尿意膀胱容量、最大膀胱容量、达峰时间、膀胱残余尿量高于术前(P<0.05)。另外,尿流时间、最大尿道压力和最大尿道闭合压术前术后并无明显差别。此外值得我们注意的是,无排尿异常患者与伴排尿异常患者两者之间术前尿动力结果比较均无明显差异(P>0.05),而两者术后尿动力结果比较其差别均有统计学意义(P<0.05);不同临床分期之间、不同病理类型之间排尿异常情况及尿动力学检查结果比较差异均无统计学意义(P>0.05)。结论子宫颈癌根治术后伴排尿异常患者的尿动力特点主要表现为膀胱感觉功能减退和逼尿肌功能异常,而尿动力学检查可提供客观的临床指标进行早期诊断。

Objective To explore the urodynamic characteristics of bladder function in patients with abnormal urination after radical hysterectomy of cervical cancer.Methods In a prospective self-controlled study,a total of 84 patients with cervical cancer and clinical stage ofⅠB toⅡA,meeting the preoperative inclusion criteria in our hospital from January 2016 to June 2018 were enrolled.All patients were tested for urodynamic testing 1 week before and 6 months after surgery.Patient bladder function status was observed and evaluated before and after surgery and urodynamic examination results were analyzed.Results Of 84 study cases,the 58 patients developed abnormal urination after radical surgery,there were no urination abnormalities in 26 cases.There was no significant difference in age,clinical stage and pathological diagnosis between patients with and without urination abnormalities.Abnormal urination after radical surgery included difficulty in urinating(55%),frequent urination with a feeling of urination not complete(34%),stress urinary incontinence(7%),and urinary incontinence(4%).Among the 26 patients without urination abnormalities after radical surgery,only one case showed an abnormal urodynamic examination(abnormal bladder sensation).In patients without abnormal urination after surgery,differences in the urodynamic examination findings between pre-and post-surgery were not statistically significant(all P>0.05).At the same time,in all cases of abnormal urination after radical hysterectomy of cervical cancer,43 patients(74%)with bladder dysfunction had normal urination pattern before operation,but after operation,the urination abnormality required abdominal pressure.Of the patients with bladder dysfunction after surgery,the maximum flow rate(Qmax)was(12.9±10.3)ml/s,the average flow rate(Qave)was(6.0±4.2)ml/s,the voided volume was(148.0±36.8)ml,voiding time was(32.9±22.1)s,maximum flow time was(11.4±5.0)s,postvoid residual urine was(260.2±219.2)ml,maximal detrusor pressure was(12.1±8.9)cmH_(2)O,bladder compliance was(16.1±4.3)ml/cmH_(2)O,normal desire to void was(354.5±204.3)ml,maximal capacity was(587.4±152.5)ml,maximum urethral pressure was(97.6±33.1)cmH_(2)O,maximum urethral closure pressure was(89.9±36.4)cmH_(2)O,and function urethral length was(29.6±6.5)mm;In comparison,the above indexes-corresponding values at 1 week before surgery were respectively as follows:the Qmax was(25.1±11.4)ml/s,the Qave was(11.4±6.6)ml/s,the voided volume was(318.6±96.4)ml,voiding time was(29.2±18.5)s,maximum flow time was(6.7±3.9)s,postvoid residual urine was(29.9±21.5)ml,maximal detrusor pressure was(31.9±21.4)cmH_(2)O,bladder compliance was(78.1±33.9)ml/cmH_(2)O,normal desire to void was(258.2±185.5)ml,maximal capacity was(335.1±124.9)ml,maximum urethral pressure was(96.4±33.9)cm H_(2)O,maximum urethral closure pressure was(88.5±35.2)cmH_(2)O,and function urethral length was(37.2±7.2)mm.It can be seen that Qmax,Qave,voided volume,maximum detrusor pressure,bladder compliance,and functional urethral length in patients with abnormal urination are significantly lower after radical hysterectomy of cervical cancer than before the surgery.While,normal desire to void,maximum capacity,maximum flow time,and postvoid residual urine volume were higher after radical hysterectomy than before surgery(P<0.05).In addition,there was no significant difference in voiding time,maximum urethral pressure and maximum urethral closure pressure between pre-and post-operation.Besides,it is worth noting that there was no significant difference in preoperative urodynamic test results between patients without abnormal urination versus patients with abnormal urination(P>0.05),and the difference in urodynamic test results between the two groups is statistically significant(P<0.05).There was no statistically significant difference in abnormal urination and in urodynamic test results between different clinical stages and between different pathological types(P>0.05).Conclusions The characteristics of urinary dynamics in patients with abnormal urination after radical hysterectomy of cervical cancer are mainly manifested as decreased bladder sensory function and abnormal detrusor function.And the urodynamic test can provide objective clinical indicators for early diagnosis.