溴吡斯的明联合坦索罗辛对根治性子宫切除术后膀胱功能障碍的疗效及尿流动力学的影响

Effect of pyridostigmine bromide combined with tamsulosin on prevention and treatment of bladder dysfunction and urodynamic changes after radical hysterectomy

目的 评价溴吡斯的明联合坦索罗辛对根治性子宫切除术后膀胱功能障碍的疗效及对尿流动力学的影响。方法 按照随机数字表法将2019年8月—2022年3月于甘肃省肿瘤医院行根治性子宫切除术的120例宫颈癌患者分为A、B、C组,每组40例。A组术后5 d接受溴吡斯的明治疗;B组采取单纯导尿治疗;C组术后5 d接受溴吡斯的明联合坦索罗辛治疗。比较3组术后不同时间点的残余尿量、下尿路/膀胱功能障碍量表(MHU)评分、尿流动力学指标、并发症、留置导尿管总时间、术后膀胱功能恢复情况及不良反应。结果 3组不同时间点的残余尿量、MHU评分、膀胱最大容量、膀胱初感容量、逼尿肌顺应性比较,采用重复测量设计的方差分析,结果:(1)不同时间点的残余尿量、MHU评分、膀胱最大容量、膀胱初感容量、逼尿肌顺应性有差异(P <0.05);(2)3组的残余尿量、MHU评分、膀胱最大容量、膀胱初感容量、逼尿肌顺应性有差异(P <0.05),C组术后2周、术后3周、术后2个月与术后3个月的残余尿量、MHU评分均低于A组、B组,膀胱最大容量、膀胱初感容量、逼尿肌顺应性均高于A组、B组;(3)3组残余尿量、MHU评分、膀胱最大容量、膀胱初感容量、逼尿肌顺应性的变化趋势有差异(P <0.05)。C组术后下尿路/膀胱感染发生率低于A组、B组(P <0.05),留置导尿管总时间短于A组、B组(P <0.05);C组术后2个月膀胱功能等级优于A组、B组(P <0.05);3组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 溴吡斯的明联合坦索罗辛可有效防治根治性子宫切除术后膀胱功能障碍,促进患者术后膀胱功能恢复,缩短留置导尿管时间,改善尿流动力学指标,减少下尿路/膀胱感染发生,且未明显增加不良反应。

Objective To evaluate the efficacy of pyridostigmine bromide combined with tamsulosin in the prevention and treatment of bladder dysfunction after radical hysterectomy and its impact on urodynamics.Methods A total of 120 cervical cancer patients undergoing radical hysterectomy in Gansu Tumor Hospital from August 2019 to March 2022 were divided into three groups according to the random number table method. Forty cases in group A were treated with pyridostigmine bromide 5d after operation. 40 cases in group B were treated with simple urethral catheterization;and 40 cases in the group C were treated with pyridostigmine bromide combined with tamsulosin 5d after operation. The residual urine volume, lower urinary tract/bladder dysfunction scale(MHU)score, and urodynamic index changes at different time points after surgery were observed in the three groups, and the complications, total time of indwelling urinary catheter, postoperative bladder function recovery, and adverse effects were compared among the three groups. Results The residual urine volume, MHU score, bladder maximum capacity, bladder initially sensed capacity, and detrusor compliance in three groups at different time points were compared using the repeated measures design analysis of variance. The results showed that(1) There were significant differences in residual urine volume, MHU score, bladder maximum capacity, bladder initially sensed capacity, and detrusor compliance at different time points(P < 0.05).(2) The differences of residual urine volume,MHU score, maximum bladder capacity, initially sensed bladder capacity, and detrusor compliance among the three groups were statistically significant(P < 0.05);the residual urine volume and MHU score in group C at two weeks,three weeks, two months, and three months after surgery were lower than those in group A and group B;the maximum bladder capacity, initially sensed bladder capacity, and detrusor compliance were higher than those in group A and group B.(3) The trend differences of residual urine volume, MHU score, bladder maximum capacity,bladder initial sensation capacity, and detrusor compliance were statistically significant(P < 0.05);the incidence of postoperative lower urinary tract/bladder infection and total duration of indwelling urinary catheter in group C were lower than those in groups A and B(P < 0.05);the bladder function grade at 2 months after surgery was better in group C than in groups A and B(P < 0.05);the difference was not statistically significant when comparing the incidence of adverse reactions in the three groups(P > 0.05). Conclusion The combined use of pyridostigmine bromide and tamsulosin can effectively prevent and treat bladder dysfunction after radical hysterectomy, promote postoperative bladder function recovery, shorten the time of indwelling urinary catheter, improve urodynamics, and reduce the incidence of lower urinary tract/bladder infection, and did not significantly increase adverse reactions.