摘要
目的:探讨术前、术后尿动力学检测及其对合并肾积水、肾功能损害的临床意义。方法:膀胱出口梗阻≥Ⅲ度的BPH患者按是否合并肾积水、肾功能损害分为两组,即无合并症的A组198例,有合并症的B组48例,记录术前、术后2次影像、尿动力学、肾功能等检查结果,对A、B组间和B组术前、术后结果进行比较分析。结果:(1)术前合并低顺应性膀胱(low compliance bladderLCB),膀胱逼尿肌括约肌协同失调(detrusor sphincter dyssynergia DSD),逼尿肌活动亢进(detrusor overactivity DO)的患者,A、B组分别18.2%、29.3%、29.3%和83.3%、54.2%、14.6%,不稳定膀胱(detrusor instability DI)、膀胱逼尿肌收缩功能损害(detrusorcontractile functional lesion IDC)早期、IDC中晚期的患者,A、B组分别为128例、39例、6例和19例、18例、8例(P<0.01);(2)A、B组间术前、术后DI、IDC早期、尿动力学残余尿量(residual urine RU)、充盈期膀胱压力(filling phase dertusor pressure FPPdet)、排尿期膀胱压力(urination phrase dertusor pressure UPPdet)最大尿流率(maximum flow rate MFR)差异有显著性(P<0.05)。(3)术前、术后3个月B组IDC中晚期尿动力学参数有变化,大多仍未能恢复,高顺应性膀胱(High compliance bladder HCB)尿动力学参数差异无统计学意义(P>0.05)。结论:BPH无合并肾积水、肾功能损害患者,应争取在PCB前手术,可避免肾并发症发生;合并肾积水、肾功能损害,争取在IDC早期前,或者PCB合并其他膀胱功能改变前手术,有助于肾积水、肾功能损害的恢复;如已是IDC晚期及HCP的患者,则肾积水、肾功能损害3个月内恢复效果较差。
Objective： To investigate urodynamics before and after prostatectomy for the recoverability of BPH patients complicating with nephrohydrops and renal dysfunction. Methods： From Jan.2003 to sep.2008 246 patients with BPH exceeding grade 3 of bladder outlet obstruction were studied by urodynamic pre-and post-operation. The 246 patients were divided into two groups： the group with nephrohydrops and renal dysfunction （group A） and the group without nephrohydrops and renal dysfimction （group B）. Record the two groups＇ results of imageology urodynamics renal function and other results, then compare the results of the tw o groups. Result： （1）Before prostatectomy the patients were 18.2% with LCP, 29.3% with DSD and 29.3% with DO in group A, while were 83.3%, 54.2%and 14.6% in group B repsectively. The patients with DI, light IDC, moderately-severely IDC were respectively 128, 39 and 6 in group A, while 19, 18 and 8 in group B（P〈0.01）.（2） The patients before operation with DI, light IDC, moderately-severely IDC are different in RU, FPPde, UPPdet MFR of the patients after operation （P 〈0.05）. （3） The group B parameters before operation are different from the one 3 months after operation. But most parameters are not recovered. The patients with HCP parameters are not of statistical significance （P〉0. 05）. Conclusion： The patient without nephrohydrosis should have operation before having poorly compliant bladders so that can avoid nephrohydrosis and kidney functional lesion. If having those damages, he should have operation before bladder IDC or poorly compliant bladder with other changed bladder function. That helps reverting complications. If he is in the bladder IDC advanced stage and （or） with high compliance bladder, there would be most damages hard to recover. Dynamic state of urine dynamics can help to estimate the patient＇s bladder function and prognosis.
出处
《现代生物医学进展》
CAS
2009年第6期1122-1125,共4页
Progress in Modern Biomedicine
关键词
前列腺增生
尿动力学
肾积水
肾功能损害
Benign prostatic hyperplasia
Urodynamics
Nephrohydrops
Renal functional lesion
