本文選題：前列腺增生　切入點(diǎn)：膀胱出口梗阻　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：[背景]逼尿肌活動低下(detrusor underactivity,DU)或稱逼尿肌無力是泌尿外科常見的下尿路功能障礙,是今年的一個(gè)研究熱點(diǎn)。ICS對DU的定義是:因逼尿肌收縮力量減弱或收縮持續(xù)時(shí)間縮短造成膀胱排空時(shí)間延長或不能在一定時(shí)間內(nèi)徹底排空膀胱。尿流動力學(xué)是診斷DU的金標(biāo)準(zhǔn),但一直以來DU缺乏統(tǒng)一的尿流動力學(xué)診斷標(biāo)準(zhǔn)。文獻(xiàn)一般將膀胱收縮指數(shù)(bladder contractility index,BCI)低于100,或最大瓦特指數(shù)(Wmax)低于7w/m2作為診斷DU的標(biāo)準(zhǔn),但最近德國一個(gè)研究小組發(fā)現(xiàn):BCI及Wmax隨BPH梗阻程度的增加而增大,因而,以單一的閾值診斷DU是不合適的,基于這一發(fā)現(xiàn),他們根據(jù)梗阻指數(shù)(BOOI)=Pdet@Qmax-2Qmax 和 WFmax 建立了 Maastricht-Hannover 列線圖(M-H),他們聲稱該列線圖可以用于診斷不同梗阻程度病人的DU,是一種新的更全面合理的DU診斷標(biāo)準(zhǔn),但這一列線圖并沒有得到其他研究小組的驗(yàn)證和認(rèn)同。[實(shí)驗(yàn)?zāi)康腯本研究旨在通過回顧性分析我院前列腺增生(BPH)病人的尿動資料,比較這一新的列線圖與通常使用的Schaefer列線圖及Pdet@Qmax小于40cmH2O的診斷標(biāo)準(zhǔn)診斷DU的差異,從而評價(jià)M-H列線圖診斷DU的合理性。[實(shí)驗(yàn)方法]回顧性分析了 2014年7月-2017年1月在我院行尿動學(xué)檢查,具有下尿路癥狀(LUTS)161例BPH病人的尿動資料。患者平均年齡66±3歲(50歲-79歲)。BPH的診斷依據(jù)術(shù)前B超、PSA水平及肛診并經(jīng)過術(shù)中證實(shí),同時(shí)排除神經(jīng)源性膀胱、前列腺癌、尿道狹窄及急性泌尿系感染者。測定最大自由尿流率(Qmax)、插管殘余尿量及膀胱容量。壓力-流率測定排尿期最大尿流率時(shí)逼尿肌壓力(Pdet@Qmax)及最大尿流率(Qmax)。梗阻程度根據(jù)Schaefer列線圖分為 0-Ⅵ 共 7級。計(jì)算逼尿肌收縮指數(shù)(detrusor contraction coefficient,DECO),DECO=Pdet@Qmax+5Qmax/l 00,膀胱收縮指數(shù)(Bladdercontractility index,BCI),BCI= Pdet@Qmax+5Qmax及膀胱出口梗阻指數(shù)(bladder obstruction index,BOOI),BOOI=Pdet.Qmax-2Qmax,最大瓦特指數(shù)(Wmax)由儀器自動給出。分別以M-H列線圖、Scheafer列線圖及Pdet@Qmax小于40cmH2O三個(gè)標(biāo)準(zhǔn)診斷DU的存在;計(jì)算三個(gè)標(biāo)準(zhǔn)的符合率;分析M-H列線圖診斷的DU病人的逼尿肌收縮功能。[實(shí)驗(yàn)結(jié)果]1.膀胱收縮指數(shù)BCI和最大瓦特指數(shù)Wmax隨著梗阻程度的增加而增大,BCI從0級的63.5±10.3升高到Ⅵ級的171.9±13.1;Wmax從0級的6.1±1.5升高至Ⅵ級的24.6±4.7。2.當(dāng)梗阻程度在SchaeferO-Ⅱ時(shí),三種DU診斷標(biāo)準(zhǔn)具有較高的符合率(60-100%),當(dāng)梗阻程度在SchaeferⅢ-Ⅵ時(shí),只有M-H列線圖能診斷出DU,三個(gè)標(biāo)準(zhǔn)的符合率為0%。3.在被M-H診斷為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)的患者逼尿肌收縮力在Schaefer列線圖中處于正常和較強(qiáng)范圍,59%(29/49)的患者Wmax大于 10W/m2,57%(28/49)的患者BCI大于 100。[實(shí)驗(yàn)結(jié)論]前列腺增生患者的BCI和Wmax隨著梗阻程度的增加而增大,但以M-H列線圖作為梗阻程度為Ⅲ-Ⅵ級DU患者的診斷標(biāo)準(zhǔn)是不合理的,將出現(xiàn)假陽性。BCI、Wmax、等容逼尿肌壓力和Schaefer列線圖仍然是臨床實(shí)用的DU診斷標(biāo)準(zhǔn)。
[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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R697.3

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