盆腔器官脱垂患者复位前后尿动力学变化特点

摘要

目的 探讨盆腔器官脱垂患者复位前后尿动力学变化的特点.方法 对2010年1至4月间北京大学人民医院妇科收治的30例盆腔器官脱垂(其中Ⅰ度1例、Ⅱ度6例、Ⅲ度21例、Ⅳ度2例)患者进行尿动力学检查,然后行圆盘形子宫托复位,复位后立即再次行尿动力学检查.结果 (1)复位前后症状:复位前膀胱出口梗阻者11例、残余尿量＞100 ml者7例、压力性尿失禁者4例;复位后膀胱出口梗阻者5例、残余尿量＞100 ml者5例、压力性尿失禁者4例.(2)复位前后尿动力学检查结果:所有患者复位前后最初排尿感容量(P=0.047)、正常排尿感容量(P=0.007)、强烈排尿感容量(P=0.001)、最大膀胱测压容量(P=0.001)、最大尿流率(P=0.001)、平均尿流率(P=0.001)、残余尿量(P=0.025)比较,差异均有统计学意义.阴道前壁Ⅰ～Ⅱ度脱垂者最大尿流率复位前为(11±6)ml/s,复位后为(15±4)ml/s,两者比较,差异有统计学意义(P=0.014);平均尿流率复位前为(6±4)ml/s,复位后(7±3)ml/s,两者比较,差异无统计学意义(P=0.237);残余尿量复位前为(29±46)ml,复位后(15±25)ml,两者比较,差异无统计学意义(P=0.157).阴道前壁Ⅲ～Ⅳ度脱垂者最大尿流率复位前为(11±8)ml/s,复位后为(17±10)ml/s,两者比较,差异有统计学意义(P=0.001);平均尿流率复位前为(5±4)ml/s,复位后(7±4)ml/s,两者比较,差异有统计学意义(P=0.002);残余尿量复位前为(105±169)ml,复位后为(47±92)ml,两者比较,差异也有统计学意义(P=0.037).结论 盆腔器官脱垂Ⅲ～Ⅳ度者具有假性膀胱出口梗阻、隐性压力性尿失禁和残余尿量＞100 ml的特点,复位后较复位前的排尿感容量、尿流率和残余尿量有明显改善,复位后的尿动力学检查结果可以更好地反映患者的下尿路情况.%Objective To study the urodynamic characteristics of women with pelvic organ prolapse in prolapse and reset condition. Methods From Jan. 2010 to Apr. 2010, 30 patients with pelvic organ prolapse (POP), including 1 case in grade Ⅰ , 6 cases in grade Ⅱ , 21 cases in grade Ⅲ and 2 cases in grade Ⅳ, treated in Peking University People's Hospital were analyzed their urodynamical changes at status of prolapse and reset with pessary. Results (1)The symptoms: in the prolapse condition, there were 11 patients with bladder outlet obstruction( BOO), 7 patients with residual volume more than 100 ml, and 4 patients with stress urinary incontinence(SUI). In the reset condition, there were 5 patients with BOO,5 patients with residual volume more than 100 ml, and 4 SUI patients. (2) Characteristics of urodynamic:there were significant difference in first desire to void ( FD, P = 0. 047), normal desire to void ( ND, P =0. 007), strong desire to void ( SD, P = 0. 001 ), maximum cystometric capacity ( MCC, P = 0. 001 ),maximum flow rate ( Q=max, P = 0. 001 ), average flow rate ( Q P = 0. 001 ), and residual volume ( RV,P = 0. 025 ) between prolapse and reset condition among all patients. In patients with grade Ⅰ to Ⅱprolapse, Qmax were (11 ±6) ml/s in prolapse condition and (15 ±4) ml/s in reset condition (P =0. 014), Qave were ( 6 ± 4 ) ml/s in prolapse condition and ( 7 ± 3 ) ml/s in reset condition ( P = 0. 237 ),RV were (29 ±46) ml in prolapse condition and (15 ±25) ml in reset condition (P =0. 157). Among patients with grade Ⅲ to Ⅳ prolapse, Qmax were ( 11 ± 8 ) ml/s in prolapse condition and ( 17 ± 10) ml/s in reset condition (P=0.001), Qave were (5 ±4) ml/s in prolapse condition and (7 ±4) ml/s in reset condition ( P = 0. 002 ), RV were ( 105 ± 169 ) ml in prolapse condition and (47 ± 92) ml in reset condition (P = 0. 037 ). Conclusions Patients with pelvic organ prolapse Ⅲ - Ⅳ may present pseudo BOO,recessive stress urinary incontinence and residual volume more than 100 ml. There were significant improvement in cystometric sensation, capacity, flow rate, and residual volume after reset. The urodynamic test for patients with pelvic organ prolapse in the reset condition might be much better in evaluating lower urinary tract function.