神经源性膀胱合并上尿路扩张影像尿动力学特点分析

发布时间：2018-02-08 11:36

本文关键词： 膀胱神经源性影像尿动力学上尿路扩张　出处：《郑州大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的本研究比较上尿路扩张组和无上尿路扩张组神经源性膀胱患者(NBSD)之间尿动力学参数差异,以及两组患者膀胱形态、排尿期膀胱颈口和尿道开放情况以及上尿路返流情况,探讨合并上尿路扩张的神经源性膀胱患者X线影像尿动力学特点,为临床预防和治疗NBSD患者发生上尿路损害以及评估预后提供参考。方法选取2011年4月-2012年2月在郑州大学第一附属医院尿动力学中心进行X-线影像尿动力学检查的神经源性膀胱伴上尿路扩张患者25例,其中男12例,女13例,年龄3～55岁(平均29±17岁)。同时选取经B超或泌尿系造影检查证实无上尿路扩张神经源性膀胱患者25例作为对照组,男13例,女12例,年龄5～47岁(27±16)岁。采用MMS尿动力学检测仪,飞利浦公司移动式C型臂X线机。患者先进行自由尿流率测定,然后男性患者取站立位,儿童和女性患者取坐位,经尿道留置10F(成人)或6F(儿童)双腔膀胱测压管,直肠内留置一次性测压导管并妥善固定。400ml生理盐水中注入76%泛影葡胺100ml,配成浓度为15%的泛影葡胺灌注液。按照国际尿控协会推荐方法[4]记录膀胱压力(Pves)、直肠压力(Pabd)、逼尿肌压力(Pdet)等参数。注意观察最大测压膀胱容量(MCC)、膀胱顺应性(BC)、逼尿肌收缩力和稳定性、逼尿肌漏尿点压(DLPP)。比较两组尿动力学参数差异。结果上尿路扩张组膀胱形态异常者占80%,显著高于对照组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%),膀胱形态呈典型“圣诞树”或“宝塔”样改变者9例(36%)。而对照组膀胱形态异常者7例(28%),有憩室形成者仅3例(12%)。上尿路扩张组BC显著低于无扩张组,DLPP、PVR显著高于对照组(P0.05),而两组最大膀胱容量差异无统计学意义(P0.05)。上尿路扩张组膀胱输尿管返流者7例,其中5例为低压返流,对照组无1例发现膀胱输尿管返流。上尿路扩张组逼尿肌无收缩发生率85%,显著高于无扩张组29%(P0.05)。上尿路扩张组DLPP40cmH2O者占45%,明显高于对照组(14%)；膀胱颈口开放异常者占(75%)(P0.05),明显高于对照组(33%)(P0.05)。结论伴随上尿路扩张的神经源性膀胱患者多有膀胱壁毛糙、小梁憩室形成,严重者可呈“圣诞树”或“宝塔”样改变,膀胱颈口开放异常,膀胱输尿管返流发生率高,对神经源性膀胱患者进行X线影像尿动力学检查,可以有效评估膀胱和上尿路形态及功能的改变,为临床治疗和评估预后提供依据。
[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 卤17 years old (mean 29 卤55 years old). Twenty-five patients (male 13, female 12, age 547 years, 27 卤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.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.7

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