论文部分内容阅读
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。
Objective: To investigate the changes of bladder function in patients undergoing extensive hysterectomy and its significance. METHODS: 63 patients with stage IB1 to IIA cervical cancer underwent urodynamic testing before and after radical mastectomy, including filling cystometry, pressure flow synchronization, and sphincter electromyography. Results: The bladder initial capacity and residual urine volume after radical surgery for cervical cancer were significantly higher than before surgery (P<0.01). Detrusor pressure was measured at the time of maximal bladder capacity, compliance, maximum urinary flow rate, and maximum urinary flow rate. All were significantly lower than before surgery (P<0.01). Postoperatively, 34 patients (54.0%) had urodynamic findings of recent bladder dysfunction, including detrusor damage, low compliance bladder, bladder outflow obstruction, detrusor sphincter dyssynergia, and detrusor overactivity. Activities, including low compliance bladder and detrusor damage were significantly higher than preoperative (P <0.01). Postoperative urinary retention occurred in 18 patients (28.6%), and detrusor damage (66.7%) and detrusor overactivity (33.3%) were significantly higher in patients with urinary retention than in non-urinary retention patients (respectively 20.0% and 4.4%). Conclusion: The bladder function in patients with cervical cancer after radical mastectomy has obvious changes. It can be manifested as multiple types of bladder dysfunction, and mainly with low compliance bladder and detrusor muscle damage, and detrusor muscle damage may lead to surgery. The main reason for post urinary retention. Urodynamic examination is of great significance in the analysis of the cause of postoperative bladder dysfunction and in guiding treatment.