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目的 探讨W形原位回肠代膀胱患者尿动力学特点及形成机理。 方法 对20例膀胱全切、W形原位回肠代膀胱患者行尿动力学评估,包括填写排尿情况问卷、尿流率、剩余尿测定、代膀胱测压、压力/流率测定和静态尿道压力描记,同时行膀胱造影、泌尿系B超、肾功能检查和IVU。 结果 20例患者中,白天尿失禁2例,夜间尿失禁6例。代膀胱最大容量(492. 9±177. 8)ml,充盈期最大压力(32. 1±8. 6)cmH2O。尿流曲线呈持续型12例,呈间歇型8例。持续型最大尿流率为(14. 9±2. 5 )ml/s,间歇型为( 7. 7±2. 8 )ml/s,代膀胱容量分别为( 409. 0±96. 1 )ml和( 622. 1±197. 7)ml,剩余尿量分别为(9. 2±11. 8)ml和(69. 0±38. 4 )ml; 2组比较差异均有统计学意义(P<0. 05)。膀胱尿道造影提示:持续尿流型代膀胱颈口呈漏斗型,排尿时开放良好;而间歇尿流型代膀胱颈口不呈漏斗型或排尿时颈口开放欠佳。 结论 W形原位回肠代膀胱有较好的储尿和排尿功能,并发症低;排尿时存在持续型尿流和间歇型尿流两种形式,具有各自的尿动力学特点;其形成机理主要与代膀胱颈口形状和开放程度相关。
Objective To investigate the urodynamic features and formation mechanism of W-shaped ileal bladder patients. Methods Twenty patients undergoing total bladder resection and W-shaped ileal urinary bladder evaluation were included in the questionnaire, including urinary questionnaire, urinary flow rate, residual urine test, urinary bladder pressure, pressure / flow rate and static urethral pressure Tracing, simultaneous cystography, urinary tract ultrasound B, renal function tests and IVU. Results In 20 patients, 2 cases of incontinence during daytime and 6 cases of incontinence during nighttime. On behalf of the maximum capacity of the bladder (492. 9 ± 177 8) ml, filling the maximum pressure (32.1 ± 8. 6) cmH2O. Urinary flow curve showed a continuous type in 12 cases, intermittent type in 8 cases. Continuous maximal uroflow rate was (14.9 ± 2.5) ml / s, intermittent type was (7.7 ± 2.8) ml / s, on behalf of the bladder capacity were (409. 0 ± 96 1) ml and (622.1 ± 197.7) ml, the residual urine volume was (9.2 ± 11.8) ml and (69.0 ± 38.4) ml, respectively; the differences between the two groups were statistically significant ( P <0. 05). Bladder urethrography tips: continuous urinary flow on behalf of the bladder neck was funnel-type mouth, voiding open well; and intermittent urinary flow on behalf of the bladder neck was not funnel-type or urination neck opening poor. Conclusion The W-shaped ileum bladder has better urine-storing and urinating functions and lower complication rate. There are two types of continuous urinary flow and intermittent urinary flow in urination, which have their own urodynamic characteristics. And on behalf of the bladder neck shape and open degree related.