CAJ | 학술논문

目的:探讨广泛全子宫切除术后患者近期膀胱功能的变化及其意义.方法:63例ⅠB1～ⅡA期宫颈癌患者在宫颈癌根治术前及术后接受尿动力学检测,包括充盈性膀胱测压、压力流率同步测定和括约肌肌电图检查.结果:宫颈癌根治术后近期膀胱初感容量和残余尿量均较术前明显增加(P＜0.01),最大膀胱容量、顺应性、最大尿流率及最大尿流率时的逼尿肌压力均较术前明显降低(P＜0.01).术后,34例患者(54.0%)尿动力学检测发现存在近期膀胱功能障碍,包括逼尿肌受损、低顺应性膀胱、膀胱流出道梗阻、逼尿肌外括约肌协同失调及逼尿肌过度活动,其中低顺应性膀胱和逼尿肌受损发生率明显高于术前(P＜0.01).18例患者(28.6%)发生术后尿潴留,尿潴留患者的逼尿肌受损发生率(66.7%)和逼尿肌过度活动发生率(33.3%)均明显高于非尿潴留患者(分别为20.0%和4.4%).结论:宫颈癌根治术后患者近期膀胱功能改变明显,可表现为多种类型的膀胱功能障碍,并以低顺应性膀胱和逼尿肌受损为主,而逼尿肌受损可能是导致术后尿潴留的主要原因.尿动力学检查对于术后膀胱功能障碍的病因分析及指导治疗具有重要意义.
목적:탐토엄범전자궁절제술후환자근기방광공능적변화급기의의.방법:63례ⅠB1～ⅡA기궁경암환자재궁경암근치술전급술후접수뇨동역학검측,포괄충영성방광측압、압력류솔동보측정화괄약기기전도검사.결과:궁경암근치술후근기방광초감용량화잔여뇨량균교술전명현증가(P＜0.01),최대방광용량、순응성、최대뇨류솔급최대뇨류솔시적핍뇨기압력균교술전명현강저(P＜0.01).술후,34례환자(54.0%)뇨동역학검측발현존재근기방광공능장애,포괄핍뇨기수손、저순응성방광、방광류출도경조、핍뇨기외괄약기협동실조급핍뇨기과도활동,기중저순응성방광화핍뇨기수손발생솔명현고우술전(P＜0.01).18례환자(28.6%)발생술후뇨저류,뇨저류환자적핍뇨기수손발생솔(66.7%)화핍뇨기과도활동발생솔(33.3%)균명현고우비뇨저류환자(분별위20.0%화4.4%).결론:궁경암근치술후환자근기방광공능개변명현,가표현위다충류형적방광공능장애,병이저순응성방광화핍뇨기수손위주,이핍뇨기수손가능시도치술후뇨저류적주요원인.뇨동역학검사대우술후방광공능장애적병인분석급지도치료구유중요의의.
Objective:To study the variation of recent bladder function of the patients who received radical hysterectomy and evaluate its significance. Methods:Sixty-three patients with cervical carcinoma in International Federation of Gynecology and Obstetrics(FIGO) stage IB1 to ⅡA received urodynamic examination before and after operation. The urodynamic parameters included filling cystometry, pressure-flow rate, and electromyography of sphinctienter. Results:Radical hysterectomy induced significant increase in the first sensation (P<0.01)and post voiding residual of bladder (P<0.01) ;whereas caused significant decrease in the maximum volume(P<0.01), compliance(P<0.01),maximum flow rate(P<0.01) and the pressure at the maximum flow rate(P<0.01), respectively, compared with the corresponding values before the operation. Short-term bladder dysfunctions were observed in 34 patients (54.0%) including bladder detrusor dysfunction, low compliance bladder, bladder outlet obstruction, dyssynergia of urethral external sphincter and detrusor overactivity. The incidences of low compliance bladder and bladder detrusor dysfunction increased significantly after operation (P<0.01). Urinary retention was found in 28.6%(18/63) patients. The incidences of bladder detrusor dysfunction (66.7% vs 20.0%) and detrusor overactivity (33.3% vs 4.4%) in the group with urinary retention were significantly higher than those of corresponding group without urinary retention. Conclusion:The bladder function had obvious short-term changes following radical hysterectomy. In the many types of bladder dysfunction the main dysfunctions were low compliance bladder and bladder detrusor dysfunction. The bladder detrusor dysfunction might be the major cause of the urinary retention following the surgery. Urodynamic test was important for post-operative analysis and treatment of bladder dysfunction.