Maastricht-Hannover列线图诊断前列腺增生患者逼尿肌无力的应用研究

发布时间：2018-03-03 22:19

本文选题：前列腺增生　切入点：膀胱出口梗阻　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：[背景]逼尿肌活动低下(detrusor underactivity,DU)或称逼尿肌无力是泌尿外科常见的下尿路功能障碍,是今年的一个研究热点。ICS对DU的定义是:因逼尿肌收缩力量减弱或收缩持续时间缩短造成膀胱排空时间延长或不能在一定时间内彻底排空膀胱。尿流动力学是诊断DU的金标准,但一直以来DU缺乏统一的尿流动力学诊断标准。文献一般将膀胱收缩指数(bladder contractility index,BCI)低于100,或最大瓦特指数(Wmax)低于7w/m2作为诊断DU的标准,但最近德国一个研究小组发现:BCI及Wmax随BPH梗阻程度的增加而增大,因而,以单一的阈值诊断DU是不合适的,基于这一发现,他们根据梗阻指数(BOOI)=Pdet@Qmax-2Qmax 和 WFmax 建立了 Maastricht-Hannover 列线图(M-H),他们声称该列线图可以用于诊断不同梗阻程度病人的DU,是一种新的更全面合理的DU诊断标准,但这一列线图并没有得到其他研究小组的验证和认同。[实验目的]本研究旨在通过回顾性分析我院前列腺增生(BPH)病人的尿动资料,比较这一新的列线图与通常使用的Schaefer列线图及Pdet@Qmax小于40cmH2O的诊断标准诊断DU的差异,从而评价M-H列线图诊断DU的合理性。[实验方法]回顾性分析了 2014年7月-2017年1月在我院行尿动学检查,具有下尿路症状(LUTS)161例BPH病人的尿动资料。患者平均年龄66±3岁(50岁-79岁)。BPH的诊断依据术前B超、PSA水平及肛诊并经过术中证实,同时排除神经源性膀胱、前列腺癌、尿道狭窄及急性泌尿系感染者。测定最大自由尿流率(Qmax)、插管残余尿量及膀胱容量。压力-流率测定排尿期最大尿流率时逼尿肌压力(Pdet@Qmax)及最大尿流率(Qmax)。梗阻程度根据Schaefer列线图分为 0-Ⅵ 共 7级。计算逼尿肌收缩指数(detrusor contraction coefficient,DECO),DECO=Pdet@Qmax+5Qmax/l 00,膀胱收缩指数(Bladdercontractility index,BCI),BCI= Pdet@Qmax+5Qmax及膀胱出口梗阻指数(bladder obstruction index,BOOI),BOOI=Pdet.Qmax-2Qmax,最大瓦特指数(Wmax)由仪器自动给出。分别以M-H列线图、Scheafer列线图及Pdet@Qmax小于40cmH2O三个标准诊断DU的存在;计算三个标准的符合率;分析M-H列线图诊断的DU病人的逼尿肌收缩功能。[实验结果]1.膀胱收缩指数BCI和最大瓦特指数Wmax随着梗阻程度的增加而增大,BCI从0级的63.5±10.3升高到Ⅵ级的171.9±13.1;Wmax从0级的6.1±1.5升高至Ⅵ级的24.6±4.7。2.当梗阻程度在SchaeferO-Ⅱ时,三种DU诊断标准具有较高的符合率(60-100%),当梗阻程度在SchaeferⅢ-Ⅵ时,只有M-H列线图能诊断出DU,三个标准的符合率为0%。3.在被M-H诊断为DU的49例Ⅲ-Ⅵ梗阻患者中,所有患者的Pdet@Qmax均大于40cmH2O,59%(29/49)的患者逼尿肌收缩力在Schaefer列线图中处于正常和较强范围,59%(29/49)的患者Wmax大于 10W/m2,57%(28/49)的患者BCI大于 100。[实验结论]前列腺增生患者的BCI和Wmax随着梗阻程度的增加而增大,但以M-H列线图作为梗阻程度为Ⅲ-Ⅵ级DU患者的诊断标准是不合理的,将出现假阳性。BCI、Wmax、等容逼尿肌压力和Schaefer列线图仍然是临床实用的DU诊断标准。
[Abstract]:[background] UAD (detrusor underactivity, DU) or detrusor muscle weakness is common in Department of Urology of lower urinary tract dysfunction, is a hot topic of this year's.ICS of DU is defined by weakening or contraction of detrusor contraction duration shortened by bladder emptying prolonged or not completely emptying the bladder urine in a certain period of time. Flow dynamics is the gold standard for the diagnosis of DU, but DU has been the lack of a unified urodynamic diagnosis standard. The literature generally index (bladder contractility index bladder contraction, BCI) less than 100, or the Watts index (Wmax) less than 7w/m2 as the criteria for the diagnosis of DU, but recently a group of German study found: BCI and Wmax increased with increasing BPH and degree of obstruction, the diagnosis of DU single threshold is not appropriate, based on the findings, according to their obstruction index (BOOI) =Pdet@Qmax-2Qmax Maastricht-Hannover and WFmax established a nomogram (M-H), they claimed that the nomograms can be used for the diagnosis of DU in patients with different degree of obstruction, is a new and more comprehensive and reasonable criteria for the diagnosis of DU, but this nomogram has not been validated in other study groups and identity. The experiment aim of the present study aims to review a retrospective study of benign prostatic hyperplasia (BPH) patients of urinary data, differences between the new nomogram and Schaefer nomogram and Pdet@Qmax commonly used diagnostic criteria for diagnosis of DU is less than 40cmH2O, experimental methods to evaluate the rationality.] M-H nomogram for diagnosis of DU of July 2014 -2017 January examination in our hospital urine review with lower urinary tract symptoms (LUTS) in 161 cases of BPH patients with urinary data. The average age of patients was 66 + 3 years (50 -79 years old).BPH was diagnosed by preoperative ultrasonography, PSA and rectal examination and after surgery At the same time that exclusion of neurogenic bladder, prostate cancer, urethral stricture and acute urinary tract infection. Determination of the maximum urine flow rate (Qmax) intubation, residual urine volume and bladder capacity. The pressure flow determination during voiding detrusor pressure at maximum urinary flow rate (Pdet@Qmax) and maximum urinary flow rate (Qmax) the degree of obstruction. According to the Schaefer nomogram is divided into 7 levels. The calculation of 0- VI (detrusor contraction coefficient detrusor contraction index, DECO), DECO=Pdet@Qmax+5Qmax/l index (Bladdercontractility 00, bladder contraction index, BCI), BCI= Pdet@ Qmax+5Qmax and bladder outlet obstruction index (bladder obstruction index, BOOI, BOOI=Pdet.Qmax-2Qmax), the maximum Watt exponent (Wmax) by automatic instrument given respectively. By M-H nomogram, Scheafer nomogram and Pdet@Qmax 40cmH2O less than three criteria for the diagnosis of the presence of DU; the accuracy of three standard; analysis of row M-H Detrusor function. The experimental results of DU diagnosis of]1. in patients with bladder contraction index BCI and the maximum Watt exponent Wmax increases with the increase of the degree of obstruction, BCI from the 0 level 63.5 + 10.3 increased to 171.9 VI + 13.1; Wmax 0 from the 6.1 + 1.5 increased to level 24.6 + 4.7.2. when VI the degree of obstruction in SchaeferO- II, three kinds of diagnostic criteria of DU with high coincidence rate (60-100%), when the degree of obstruction in Schaefer III - VI, only M-H nomogram can diagnose DU, three standard with the rate of 0%.3. in M-H was diagnosed in 49 cases of DU VI obstruction. All the patients with Pdet@Qmax was greater than 40cmH2O, 59% (29/49) in patients with detrusor contractility in normal and strong in the range of Schaefer nomogram, 59% (29/49) in patients with Wmax than 10W/m2,57% (28/49) in patients with BCI than 100.[experimental conclusion] patients with benign prostatic hyperplasia with BCI and Wmax. To increase the degree of resistance increases, but the M-H nomogram as the degree of obstruction III diagnostic criteria of VI in DU patients is not reasonable, there will be false positive.BCI, Wmax, and isovolumic detrusor pressure Schaefer nomogram is still practical clinical criteria for the diagnosis of DU.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R697.3

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