本文關(guān)鍵詞： 膀胱 神經(jīng)源性 影像尿動力學(xué) 上尿路擴(kuò)張　出處：《鄭州大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 本研究比較上尿路擴(kuò)張組和無上尿路擴(kuò)張組神經(jīng)源性膀胱患者(NBSD)之間尿動力學(xué)參數(shù)差異,以及兩組患者膀胱形態(tài)、排尿期膀胱頸口和尿道開放情況以及上尿路返流情況,探討合并上尿路擴(kuò)張的神經(jīng)源性膀胱患者X線影像尿動力學(xué)特點(diǎn),為臨床預(yù)防和治療NBSD患者發(fā)生上尿路損害以及評估預(yù)后提供參考。 方法 選取2011年4月-2012年2月在鄭州大學(xué)第一附屬醫(yī)院尿動力學(xué)中心進(jìn)行X-線影像尿動力學(xué)檢查的神經(jīng)源性膀胱伴上尿路擴(kuò)張患者25例,其中男12例,女13例,年齡3～55歲(平均29±17歲)。同時選取經(jīng)B超或泌尿系造影檢查證實(shí)無上尿路擴(kuò)張神經(jīng)源性膀胱患者25例作為對照組,男13例,女12例,年齡5～47歲(27±16)歲。采用MMS尿動力學(xué)檢測儀,飛利浦公司移動式C型臂X線機(jī)�；颊呦冗M(jìn)行自由尿流率測定,然后男性患者取站立位,兒童和女性患者取坐位,經(jīng)尿道留置10F(成人)或6F(兒童)雙腔膀胱測壓管,直腸內(nèi)留置一次性測壓導(dǎo)管并妥善固定。400ml生理鹽水中注入76%泛影葡胺100ml,配成濃度為15%的泛影葡胺灌注液。按照國際尿控協(xié)會推薦方法[4]記錄膀胱壓力(Pves)、直腸壓力(Pabd)、逼尿肌壓力(Pdet)等參數(shù)。注意觀察最大測壓膀胱容量(MCC)、膀胱順應(yīng)性(BC)、逼尿肌收縮力和穩(wěn)定性、逼尿肌漏尿點(diǎn)壓(DLPP)。比較兩組尿動力學(xué)參數(shù)差異。 結(jié)果 上尿路擴(kuò)張組膀胱形態(tài)異常者占80%,顯著高于對照組29%(P0.05),其中膀胱壁毛糙、有小梁形成者20例(80%),有憩室形成者14例(56%),膀胱形態(tài)呈典型“圣誕樹”或“寶塔”樣改變者9例(36%)。而對照組膀胱形態(tài)異常者7例(28%),有憩室形成者僅3例(12%)。上尿路擴(kuò)張組BC顯著低于無擴(kuò)張組,DLPP、PVR顯著高于對照組(P0.05),而兩組最大膀胱容量差異無統(tǒng)計學(xué)意義(P0.05)。上尿路擴(kuò)張組膀胱輸尿管返流者7例,其中5例為低壓返流,對照組無1例發(fā)現(xiàn)膀胱輸尿管返流。上尿路擴(kuò)張組逼尿肌無收縮發(fā)生率85%,顯著高于無擴(kuò)張組29%(P0.05)。上尿路擴(kuò)張組DLPP40cmH2O者占45%,明顯高于對照組(14%)；膀胱頸口開放異常者占(75%)(P0.05),明顯高于對照組(33%)(P0.05)。 結(jié)論 伴隨上尿路擴(kuò)張的神經(jīng)源性膀胱患者多有膀胱壁毛糙、小梁憩室形成,嚴(yán)重者可呈“圣誕樹”或“寶塔”樣改變,膀胱頸口開放異常,膀胱輸尿管返流發(fā)生率高,對神經(jīng)源性膀胱患者進(jìn)行X線影像尿動力學(xué)檢查,可以有效評估膀胱和上尿路形態(tài)及功能的改變,為臨床治療和評估預(yù)后提供依據(jù)。
[Abstract]:Purpose. The purpose of this study was to compare the difference of urodynamic parameters between the upper urinary tract dilatation group and the supreme urinary tract dilatation group in neurogenic bladder patients (NBSDs), as well as the shape of the bladder, the opening of the neck and urethra and the reflux of the upper urinary tract in the two groups. To investigate the urodynamic characteristics of neurogenic bladder patients complicated with upper urinary tract dilatation, and to provide a reference for clinical prevention and treatment of upper urinary tract damage in patients with NBSD and the evaluation of prognosis. Method. From April 2011 to February 2012, 25 patients (12 males and 13 females) with neurogenic bladder with upper urinary tract dilatation were examined by X-ray urodynamics in the Urodynamics Center of the first affiliated Hospital of Zhengzhou University. The mean age was 29 鹵17 years old (mean 29 鹵55 years old). Twenty-five patients (male 13, female 12, age 547 years, 27 鹵16) were selected as control group. MMS urodynamic instrument was used. Philips mobile C-arm X-ray machine. The patients were performed free flow rate measurement, then the male patients took the standing position, the children and the female patients took the sitting position, and the urethral indwelling 10F (adults) or 6F (children) double-chamber bladder manometry, A disposable manometry catheter was placed in the rectum and properly fixed. 400ml of normal saline was injected with 76% ml of meglumine diatrizoate to form 15% diatrizoate perfusion solution. According to the method recommended by the International urinary Control Association [4], the bladder pressure and rectal pressure were recorded. Parameters such as Pabdou, detrusor pressure and Pdet. note that the maximal bladder capacity, bladder compliance, detrusor contractility and stability are observed. The difference of urodynamic parameters between the two groups was compared. Results. In the upper urinary tract dilatation group, 80 cases had abnormal bladder shape, which was significantly higher than that in the control group (29% P 0.05), in which the bladder wall was rough. There were 20 cases with trabeculae formation, 14 cases with diverticulum formation, 9 cases with typical "Christmas tree" or "pagoda" shape change of bladder, 7 cases with abnormal bladder shape in control group, and 3 cases with diverticulum formation. The upper urinary tract dilated. BC in group Zhang was significantly lower than that in group without dilatation (P 0.05), but there was no significant difference in maximal bladder volume between the two groups (P 0.05). There were 7 cases of ureteral reflux in upper urinary tract dilatation group. Among them, 5 cases were low pressure regurgitation. No bladder ureter reflux was found in the control group. The incidence of detrusor non-contraction was 85 in the upper urinary tract dilatation group, which was significantly higher than that in the non-dilated group (P 0.05). The proportion of DLPP40cmH2O in the upper urinary tract dilatation group was 45, which was significantly higher than that in the control group. It was significantly higher than that of the control group (P 0.05). Conclusion. Most neurogenic bladder patients with upper urinary tract dilatation have rough bladder wall, trabecular diverticulum formation, severe or "Christmas tree" or "pagoda" changes, bladder neck opening abnormal, bladder ureteral reflux rate is high. X-ray urodynamic examination in patients with neurogenic bladder can effectively evaluate the changes of morphology and function of bladder and upper urinary tract and provide evidence for clinical treatment and evaluation of prognosis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R816.7

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