[1]张瑞莉,娄安锋,王庆伟,等.回肠代膀胱术后尿动力学特征表现及上尿路损害高危因素研究[J].第三军医大学学报,2009,31(19):1835-1838.
 ZHANG Rui-li,LOU An-feng,WANG Qing-wei,et al.Urodynamic features and high risk factors of upper urinary tract deterioration for orthotopic ileal neobladder: report of 105 cases[J].J Third Mil Med Univ,2009,31(19):1835-1838.
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回肠代膀胱术后尿动力学特征表现及上尿路损害高危因素研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
31卷
期数:
2009年第19期
页码:
1835-1838
栏目:
专题报道
出版日期:
2009-10-15

文章信息/Info

Title:
Urodynamic features and high risk factors of upper urinary tract deterioration for orthotopic ileal neobladder: report of 105 cases
作者:
张瑞莉娄安锋王庆伟刘会范张国贤王焱魏金星文建国
郑州大学第一附属医院尿动力学中心,泌尿外科;河南省高等学校临床医学重点学科开放实验室
Author(s):
ZHANG Rui-li LOU An-feng WANG Qing-wei LIU Hui-fan ZHANG Guo-xian WANG Yan WEI Jin-xing WEN Jian-guo
Urodynamic Center, Department of Urology, Key-Discipline Open Laboratory for Clinical Medicine of High College and University of Henan Province, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052,China
关键词:
原位回肠代膀胱尿动力学尿流改道术
Keywords:
orthotopic ileal neobladder urodynamics urinary diversion
分类号:
R318.01;R693.501;R699.5
文献标志码:
A
摘要:
目的   探讨W形原位回肠代膀胱术后尿动力学特征表现及上尿路功能损害高危因素。   方法   回顾性分析105例[年龄39~68(54±10)岁,男性90例,女性15例]W形原位回肠代膀胱患者术后[6~36(20±6)个月,为代膀胱组]随访资料,包括尿动力学检查、泌尿系彩超、肾功能、膀胱排尿造影和排尿表现。并选取20例患者[年龄40~70(56±10)岁,男性15例,女性5例]因上尿路疾病需要手术治疗而下尿路功能正常的患者作为正常膀胱组。比较代膀胱组和正常膀胱组相关参数的变化。同时,根据有无膀胱输尿管返流将行膀胱排尿造影的代膀胱患者分为有返流组和无返流组,比较2组相应参数变化。   结果   代膀胱组尿流曲线为间断或低平尿流曲线,正常膀胱组为钟形尿流曲线;代膀胱组最大尿流率[(12±4) ml/s]显著低于正常膀胱组[(21±5) ml/s],而残余尿量、最大代膀胱容量分别为(47±22)、(533±166) ml,显著高于正常膀胱组(8±7)、(412±57) ml。代膀胱组代膀胱感觉减退,无明显尿意感,稳定性较好,仅有9例出现蠕动波,波幅较低,规律出现,并随灌注量增多频率先逐渐增加后降低,多不伴有明显感觉。共有90例(86%)患者术后3个月膀胱排尿造影随访时未见膀胱输尿管返流。但随着随访时间延长,有11例(12%)出现膀胱输尿管返流。膀胱输尿管返流患者残余尿量、最大代膀胱容量、排尿期最大代膀胱压及颈口开放不良发生率显著高于无返流患者。   结论   W型原位回肠代膀胱具有不同于正常膀胱组织特征的尿动力学表现,残余尿量、代膀胱容量、排尿期膀胱压及膀胱颈口开放不良是其上尿路功能损害的尿动力学高危因素。
Abstract:
Objective   To investigate the urodynamic features and the relative high risk factors of upper urinary tract deterioration for W-shape orthotopic ileal neobladder.    Methods   One hundred and five patients (90 men and 15 women; mean age, 54±10) which had follow-up data of W-shape orthotopic ileal neobladder (mean time 20±6 months, ileal neobladder group), and 20 patients (15 men and 5 women; mean age, 56±10, control group) with upper urinary tract diseases who had normal lower urinary tract function were included in this retrospective study. All patients were evaluated by urodynamic examinations, cystourethrography, B-ultrasound, renal function test and voiding feature. The related parameters from both groups were analyzed comparatively. Meanwhile patients who were evaluated by cystourethrography in orthotopic ileal neobladder group were divided into 2 groups, reflux group and non-reflux group according to they having vesicoureteral reflux or not. The related parameters from both groups were analyzed comparatively.    Results   Urine flow curve was interrupted or plateau shape in ileal neobladder group, but it was bell shape in control group. Maximum flow rate was 12±4 ml/s, significantly lower than it in control group (21±5 ml/s). However, postvoid residual urine volume (PVR) and maximum cystometric capacity (MCC) were 47±22 and 533±166 ml respectively in orthotopic ileal neobladder group, significantly higher than those in control group (8±7 and 412±57 ml, P<0.05). In contrast to the normal bladder, ileal neobladder had markedly decreased sensation, good stability, and not significantly desire to void. There were merely 9 patients having observed peristaltic wave, which having lower amplitudes in a certain rule and the frequency was gradually increased then reduced with augmented priming volume. In 3 months’ postoperative followed-up, there were 90 patients having no vesicoureteral reflux observed by cystourethrography, but 11 patients had vesicoureteral reflux with extension of follow-up. Compared with non-reflux group, PVR, MCC, maximum voiding pressure(MVP) and the rate of lower opening function for bladder neck were found significantly higher in reflex group.    Conclusion   W-shape orthotopic ileal neobladder has special urodynamic features, which are different from normal bladder. Increased PVR, MCC and MVP and lower opening function for bladder neck are the high risk factors of upper urinary tract deterioration.

参考文献/References:

张瑞莉,娄安锋,王庆伟,等. 回肠代膀胱术后尿动力学特征表现及上尿路损害高危因素研究[J]. 第三军医大学学报,2009,31(19):1835-1838.

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更新日期/Last Update: 2009-09-29