中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
5期
438-442
,共5页
张鹏%武治津%杨勇%张朝华%张小东
張鵬%武治津%楊勇%張朝華%張小東
장붕%무치진%양용%장조화%장소동
排尿障碍%尿动力学%诊断显像
排尿障礙%尿動力學%診斷顯像
배뇨장애%뇨동역학%진단현상
Urination disorders%Vrodynamics%Diagnostic imaging
目的 探讨影像尿动力检查(VUD)在女性下尿路排尿功能障碍疾病诊断中的应用价值.方法 2008年12月至2011年1月,我们对126例女性下尿路排尿障碍患者行VUD检查,确定排尿障碍类型,分析各类疾病的影像尿动力检查特点.结果 126例患者中存在明确神经系统病史者30例(23.8％),无明确神经系统疾病病史96例(76.2％).所有患者中有反复泌尿道感染病史72例(57.1％),肾积水患者23例(18.3％).126例患者根据VUD表现特点进行分类:(1)膀胱出口梗阻( BOO)65例:梗阻部位为膀胱颈40例(61.5％),其VUD表现为排尿期高压-低流的梗阻性曲线,同步影像显示排尿期膀胱颈未开放或开放不全；梗阻部位为远端尿道22例(33.8％),VUD表现为排尿期高压-低流的梗阻性曲线,排尿期膀胱颈开放良好,近端尿道扩张,远端尿道未显影；梗阻部位为括约肌3例(包括逼尿肌-括约肌协同失调1例,括约肌痉挛2例),VUD表现为排尿期呈现高压-低流的膀胱出口梗阻曲线,排尿期膀胱颈开放良好,逼尿肌收缩时距膀胱颈开口约1 ～2 cm处尿道未开放,近端尿道扩张,远端尿道未显影.(2)逼尿肌无反射39例(2例合并肾积水),其VUD特点为:压力-流率检查排尿期无逼尿肌自主收缩波,呈腹压排尿模式.(3)膀胱过度活动3例,其VUD特点为:膀胱储尿期可见逼尿肌不自主期相性收缩波,同时伴或不伴尿道内尿液漏出.(4)低顺应性膀胱17例(13.5％),其中伴肾积水16例,其VUD特点为:膀胱储尿期压力明显升高、膀胱安全容量及顺应性明显降低,同步影像显示其膀胱形态呈“圣诞树”样,伴或不伴输尿管反流.(5)压力性尿失禁2例.结论 女性BOO病因中以非神经原性、器质性梗阻为主.VUD通过压力-流率曲线与同步影像结合分析,为女性各类下尿路排尿障碍疾病提供准确的诊断及治疗依据.
目的 探討影像尿動力檢查(VUD)在女性下尿路排尿功能障礙疾病診斷中的應用價值.方法 2008年12月至2011年1月,我們對126例女性下尿路排尿障礙患者行VUD檢查,確定排尿障礙類型,分析各類疾病的影像尿動力檢查特點.結果 126例患者中存在明確神經繫統病史者30例(23.8％),無明確神經繫統疾病病史96例(76.2％).所有患者中有反複泌尿道感染病史72例(57.1％),腎積水患者23例(18.3％).126例患者根據VUD錶現特點進行分類:(1)膀胱齣口梗阻( BOO)65例:梗阻部位為膀胱頸40例(61.5％),其VUD錶現為排尿期高壓-低流的梗阻性麯線,同步影像顯示排尿期膀胱頸未開放或開放不全；梗阻部位為遠耑尿道22例(33.8％),VUD錶現為排尿期高壓-低流的梗阻性麯線,排尿期膀胱頸開放良好,近耑尿道擴張,遠耑尿道未顯影；梗阻部位為括約肌3例(包括逼尿肌-括約肌協同失調1例,括約肌痙攣2例),VUD錶現為排尿期呈現高壓-低流的膀胱齣口梗阻麯線,排尿期膀胱頸開放良好,逼尿肌收縮時距膀胱頸開口約1 ～2 cm處尿道未開放,近耑尿道擴張,遠耑尿道未顯影.(2)逼尿肌無反射39例(2例閤併腎積水),其VUD特點為:壓力-流率檢查排尿期無逼尿肌自主收縮波,呈腹壓排尿模式.(3)膀胱過度活動3例,其VUD特點為:膀胱儲尿期可見逼尿肌不自主期相性收縮波,同時伴或不伴尿道內尿液漏齣.(4)低順應性膀胱17例(13.5％),其中伴腎積水16例,其VUD特點為:膀胱儲尿期壓力明顯升高、膀胱安全容量及順應性明顯降低,同步影像顯示其膀胱形態呈“聖誕樹”樣,伴或不伴輸尿管反流.(5)壓力性尿失禁2例.結論 女性BOO病因中以非神經原性、器質性梗阻為主.VUD通過壓力-流率麯線與同步影像結閤分析,為女性各類下尿路排尿障礙疾病提供準確的診斷及治療依據.
목적 탐토영상뇨동력검사(VUD)재녀성하뇨로배뇨공능장애질병진단중적응용개치.방법 2008년12월지2011년1월,아문대126례녀성하뇨로배뇨장애환자행VUD검사,학정배뇨장애류형,분석각류질병적영상뇨동력검사특점.결과 126례환자중존재명학신경계통병사자30례(23.8％),무명학신경계통질병병사96례(76.2％).소유환자중유반복비뇨도감염병사72례(57.1％),신적수환자23례(18.3％).126례환자근거VUD표현특점진행분류:(1)방광출구경조( BOO)65례:경조부위위방광경40례(61.5％),기VUD표현위배뇨기고압-저류적경조성곡선,동보영상현시배뇨기방광경미개방혹개방불전；경조부위위원단뇨도22례(33.8％),VUD표현위배뇨기고압-저류적경조성곡선,배뇨기방광경개방량호,근단뇨도확장,원단뇨도미현영；경조부위위괄약기3례(포괄핍뇨기-괄약기협동실조1례,괄약기경련2례),VUD표현위배뇨기정현고압-저류적방광출구경조곡선,배뇨기방광경개방량호,핍뇨기수축시거방광경개구약1 ～2 cm처뇨도미개방,근단뇨도확장,원단뇨도미현영.(2)핍뇨기무반사39례(2례합병신적수),기VUD특점위:압력-류솔검사배뇨기무핍뇨기자주수축파,정복압배뇨모식.(3)방광과도활동3례,기VUD특점위:방광저뇨기가견핍뇨기불자주기상성수축파,동시반혹불반뇨도내뇨액루출.(4)저순응성방광17례(13.5％),기중반신적수16례,기VUD특점위:방광저뇨기압력명현승고、방광안전용량급순응성명현강저,동보영상현시기방광형태정“골탄수”양,반혹불반수뇨관반류.(5)압력성뇨실금2례.결론 녀성BOO병인중이비신경원성、기질성경조위주.VUD통과압력-류솔곡선여동보영상결합분석,위녀성각류하뇨로배뇨장애질병제공준학적진단급치료의거.
Objective To assess the value of video-urodynamic study (VUD) in the identification of lower urinary tract voiding dysfunction in female.Methods A total of 126 female patients with sign and symptoms of lower urinary tract voiding dysfunction underwent VUD from December 2008 to January 2011 in Beijing Chaoyang Hospital, The causes of voiding dysfunction were analyzed based on VUD findings.Results Neurogenic voiding dysfunction was found in 30 patients (23.8％ ),non-neurogenic voiding dysfunction was found in 96 patients (76.2％ ).The 72 patients suffered from recurrent urinary tract infection (57.1％ )and 23 patients suffered from hydronephrosis ( 18.3％ ).Based on special characteristics of video-urodynamic study,a total of 126 patients were classified as:( 1 ) Bladder outlet obstruction (BOO)was found in 65 patients.Of them,bladder neck obstruction in 40 patients (61.5％),their VUD showed “high pressure-low flow” obstructive curve and synchronic image showed bladder neck did not open in a funnel shape and no contrast was found in urethra.Distal urethral stricture in 22 patients (33.8％ ),VUD showed “high pressure-low flow” obstructive curve and synchronic image showed bladder neck open in a funnel shape,proximal urethra dilated and no contrast was found in distal urethral.Urethral sphincter obstruction in 3 patients (including detrusor-sphincter dyssynergia in 1 and sphincterismus in 2 patinets),VUD showed “high pressure-low flow” obstructive curve and synchronic image showed bladder neck open in a funnel shape,sphincteric urethra did not open,proximal urethra dilated and no contrast was found in distal urethral.(2) Detrusor areflexia (DA) was found in 39 patients (2 patients with hydronephrosis),the VUD finding was:no voluntary detrusor contraction in voiding phase,and abdominal pressure voiding pattern.(3) OAB was found in 3 patients,which VUD findings was frequent involuntary detrusor contraction at storage period with or without urine leakage. (4) Low compliance bladder was found in 17 patients ( 13.5％ ),16 patients with hydronephrosis,the VUD showed that increased bladder storage pressure with significantly decreased bladder safe capacity and compliance,appearance of the bladder as “Christmas tree”,with or without ureteral reflux.(5) And stress urinary incontinence (SUl) was in 2.Conclusions The main causes of female BOO may be non-neurogenic conditions or organic obstruction.VUD would offer valuable information for confirmed diagnosis of voiding dysfunction in female patients.
