摘要目的 探讨女性膀胱颈抬高程度与膀胱出口梗阻相关性尿动力学特点及临床意义.方法 实验组64例,筛选条件为主诉有尿频、尿急、排尿困难.排尿时间延长、下腹部胀痛不适等下尿路症状(Lower urinary tract syndrome,LUTS).对照组34例,为无LUTS症状的正常女性.所有患者均无神经系统疾病史,无糖尿病等内分泌病病史,无盆腔手术史,无尿道手术史及泌尿系畸形病史,而且体检结合辅助检查排除子宫脱垂、尿道肉阜等病史.采用Laborie公司UDS-120尿动力学检查仪对两组患者进行全面的尿动力学检查(包括自由尿流率测定、充盈期膀胱测压、压力-流率测定),后再行膀胱镜(0°镜)检查,并采用自制测量角度仪测量膀胱颈抬高的角度.结果 ①膀胱颈抬高角度α<30°,实验组1例,最大尿流率(Qura of maximum,Qmax)为16.5ml/s,残余尿(Residure volume,RV)为8ml,最大尿流率时逼尿肌压力(Pressure of detrusor at Qmax,Pdet.Qmax)为42.20cmH2O,最大逼尿肌压力(Pressure of detrusor maximum,Pdet.max)为59.5cmH2O,最大尿道闭合压(Maximum urethral close pressure,MUCP)为69.0 cmH2O;对照组23例,Qmax平均为13.28±4.53ml/s,RV平均为78.50±121.76ml,Pdet.Qmax平均为15.86±6.24 cmH2O,Pdet.max平均为31.46±7.89 cmH2O,MUCP平均为49.26±19.16 cmH2O.②膀胱颈抬高角度为30°≤α<45°,实验组42例,Qmax平均为10.36±5.72ml/s,RV平均为121.50±107.26ml,Pdet.Qmax平均为42.32±12.56cmH2O,Pdet.max平均为57.26±13.54 cmH2O,MUCP平均为79.78±19.65cmH2O;对照组11例:Qmax平均为25.56±11.30ml/s,RV平均为90.1±102.06ml,Pdet.Qmax平均为17.56±7.26cmH2O,Pdet.max平均为31.26±7.93cmH2O,MUCP平均为49.26±17.12cmH2O.Pdet.Qmax、Pdet.max、MUCP均有统计学差异(P<0.05)③膀胱颈抬高角度为α≥45°时,实验组21例,Qmax平均为8.26±3.16ml/s,RV平均为143.80±153.60ml,Pdet.Qmax平均为51.20±29.25cmH2O,Pdet.max平均为61.33±14.25 cmH2O,MUCP平均为86.23±19.35cmH2O;对照组0例.结论 Qmax、自由尿流率与膀胱颈抬高程度呈负相关,Pdet、Pdet.max、MUPP与膀胱颈抬高程度呈正相关.

abstractsObjectives To investigate the correlation of urodynamics between bladder neck hypertrophy and bladder outlet obstruction in women and clinical significance. Methods 64patients of experiment groups were defined by the chief complaint included frequency 、urgency 、dysuresia、flow delay and other LUTS( Lower urinary tract syndrome,LUTS). Control group included 34 patients with no LUTS women. All patients had no history of neurogenic diease, diabetes mellitus, pelvic surgery , urethral surgery or trauma and genitourinary infection or deformity. Urodynamic studies were performed in all patients and the parameters included those which were flow rate, volume of residual, Qmax, Pdet. Qmax, Pdet. max, MUCP. At the same time, To measure the bladder neck hypertrophy in cystourethroscope. Results ①When bladder neck hypertrophyα <30°,only one case in experiment group, the urodynamic date showed that mean Qmax was 16.5ml/s, mean RV was 8ml,mean Pdet. Qmax was 42.20cmH2O, mean Pdet. max was 39.5 cmH2O, mean MUCP was 69.0 cmH2O; While 23 cases in control group, the urodynamic date showed that mean Qmax was 13.28 ±4.53ml/s, mean RV was 78.50 ± 121.76ml,mean Pdet. Qmax was 15.86 ± 6.24 cmH2O, mean Pdet. max was 31.46 ±7.89 cmH2O, mean MUCP was 49.26 ± 19. 16 cmH2O. ?When bladder neck hypertrophy 30° ≤α <45° ,42 cases in experiment group, the urodynamic date showed that mean Qmax was 10.36 ±5.72ml/s, mean RV was 121.50 ± 107.26ml,mean Pdet. Qmax was 42.32 ± 12. 56cmH2O, mean Pdet.max was 57.26 ± 13.54 cmH2O, mean MUCP was 79. 78 ± 19. 65 cmH2O; While 11 cases in control group, the urodynamic date showed that mean Qmax was 25. 56 ± 11. 30ml/s, mean RV was 90. 1 ± 102. 06ml, mean Pdet. Qmax was 17.56 ±7.26 cmH2O, mean Pdet. max was 31.26 ±7.93 cmH2O, mean MUCP was 49. 26 ±17. 12 cmH2O. Pdet. Qmax 、Pdet. max、MUCP were different( p < 0.05 ). ③When bladder neck hypertrophyα≥ 45°, 21 cases in experiment group, the urodynamic date showed that mean Qmax was 8.26 ±3.16ml/s, mean RV was 143.80±153.60ml, mean Pdet. Qmax was 51.20 ±29. 25cmH2O, mean Pdet. max was 61. 33 ± 14. 25 cmH2O, mean MUCP was 86.23 ±19.35 cmH2O. But no patient had found in control group. Conclusions Qmax and Free Qmax were negatively correlated with bladder neck hypertrophy.