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目的:探讨伴有难治性储尿期下尿路症状(LUTS)女性膀胱黏膜白斑患者影像尿动力学变化及手术疗效。方法:选取49例伴有非神经源性难治性储尿期LUTS并确诊为膀胱黏膜白斑的女性患者为病例组,行经尿道膀胱黏膜病变电切术,术前行影像尿动力学检查,记录排尿日记、生活质量评分(QOL);术后3个月门诊随访排尿日记、QOL等并评估手术疗效。同时选取15例仅存在上尿路疾患而下尿路功能正常的女性患者为对照组,记录排尿日记,行影像尿动力学检查。结果:病例组术前充盈期膀胱呈卵圆形或圆形,壁光滑,未见膀胱颈口开放和明显漏尿;排尿期膀胱颈口开放良好、尿道显影正常,未见逼尿肌括约肌协同失调和膀胱输尿管反流等。病例组术前正常尿意容量(VND)、功能性膀胱容量(FBC)、最大膀胱测压容量(MCC)均显著低于对照组[分别为(242±46)ml vs.(344±55)ml、(298±53)ml vs.(450±51)ml、(456±59)ml vs.(524±54)ml,P<0.01]。病例组术后的24小时排尿次数和QOL均显著低于术前[分别为(10±1)次/d vs.(14±2)次/d,(3±1)分vs.(5±1)分,P<0.01)];术后FBC显著高于术前[(447±56)ml vs.(298±53)ml,P<0.01)],与对照组FBC相比差异无统计学意义[(447±56)ml vs.(450±51)ml,P>0.05)]。病例组术后的总体手术有效率为85.7%。结论:伴有难治性储尿期LUTS女性膀胱黏膜白斑患者多伴有膀胱感觉敏感,尿动力学检查可为其诊疗提供客观依据。部分患者行经尿道膀胱黏膜病变电切术可获得满意疗效。
Objective: To investigate the changes of urodynamics and surgical curative effect of female with urinary bladder leukoplakia with refractory urinary storage lower urinary tract symptoms (LUTS). Methods: Forty-nine female patients with non-neurogenic refractory urinary storage LUTS and diagnosed as bladder leukoplakia were selected as the case group and underwent transurethral resection of the bladder mucosal lesion. Urography was performed preoperatively and recorded Diuretic diary, quality of life score (QOL); 3 months postoperative follow-up urination diary, QOL and evaluate the efficacy of surgery. At the same time, 15 female patients with upper urinary tract disorders who had normal lower urinary tract function were selected as the control group. Urinary diuresis was recorded and urodynamic examination was performed. Results: The bladder of the case group was oval or round before surgery and the wall of the bladder was smooth. There was no open or obvious leakage of the bladder neck and mouth. The voiding bladder neck was well open and the urethral development was normal. There was no detrusor sphincter synergy Disorders and vesicoureteral reflux and so on. The preoperative normal urinary volume (VND), functional bladder volume (FBC) and maximum bladder volumetric pressure (MCC) in the case group were significantly lower than those in the control group [242 ± 46 ml vs. 344 ± 55 ml , (298 ± 53) ml vs. (450 ± 51) ml, (456 ± 59) ml vs. (524 ± 54) ml, P <0.01]. The frequency of urination and QOL at 24 hours after operation in the case group were significantly lower than those before operation [(10 ± 1) / d vs. (14 ± 2) / d, (3 ± 1) vs 5 ± 1), P <0.01)]. The postoperative FBC was significantly higher than that of preoperative [(447 ± 56) ml vs. (298 ± 53) ml, P <0.01) Significance [(447 ± 56) ml vs. (450 ± 51) ml, P> 0.05)]. The overall operative efficiency of the case group was 85.7%. CONCLUSIONS: Bladder mucosal leukoplakia in LUTS women with refractory urinary storage may be more sensitive to urinary bladder sensation. Urodynamic examination may provide an objective basis for their diagnosis and treatment. Some patients with transurethral resection of bladder mucosal lesions can be obtained satisfactory results.