良性前列腺增生患者经耻骨上膀胱造瘘与经尿道置管两种方法行排尿期压力-流率测定的比较与评价

目的:通过对良性前列腺增生(BPH)患者经耻骨上膀胱造瘘与经尿道置管两种方法行排尿期压力-流率测定的结果比较,探讨应用前者的必要性。方法:对23例平均年龄为69.3(57~77)岁的患者同时以经耻骨上膀胱造瘘与经尿道置管两种方法行排尿期压力-流率测定,对相应参数以配对t检验进行统计比较。结果:①经耻骨上膀胱造瘘与经尿道置管相比,最大尿流率(Qmax)提高约1.19 ml/s(P<0.05);最大尿流率时逼尿肌压力(Pdet,Qmax)减少约10.57 cmH2O(P<0.05);组特异性尿道阻力因子(URA)减少约11.39 cmH2O(P<0.01);AG(Pdet,Qmax-2Qmax)数减小约12.94(P<0.01);最大膀胱容量增加约66.61 ml(P<0.01)。②分别以schafer图所示、AG数>40为判定梗阻的标准,经耻骨上膀胱造瘘的梗阻数均为16(69.6%),而以尿道置测压管均为20(87.0%),前者例数比后者减少。结论:行排尿期压力-流率测定时,经耻骨上膀胱造瘘与经尿道置管两种方法各有利弊,对BPH患者,主张选择前者。对于其它疾病患者应视具体情况而定。

Suprapubic Puncture: Preferable to Transurethral Catheterization for Pressure-Flow Determination in BPH Patients

Objective ： To compare suprapubic puncture and transurethral catheterization for pressure-flow determination during voiding in BPH patients. Methods： Both suprapubie puncture and transurethral catheterization were used for pressure-flow determinations during voiding in 23 BPH patients at the mean age of 69.3 years （range 57-77 years） and the related parameters were compared by ttest. Results ： Compared with transurethral catheterization, suprapubic puncture increased Qmax by 1.19 ml/s （ P 〈 0.05 ） and MMC by 66.61 ml （P〈0.01）, and reduced the pressure of detrusor at Qmax （Pdet, Qmax） by 10.57 cmH2O （P 〈0.05）, URA by 11.39 cmH2O （ P 〈 0.01 ） and AG by 12.94 （ P 〈 0.01 ）. Either according to the Schafer diagram or with AG 〉 40 as the diagnostic standard, there were 16 （69.6%） cases of bladder outlet obstruction （BOO） in the suprapubic puncture group and 20 （87.0%） in the transurethral catheterization group. Conclusion： In pressure-flow determination during voiding, suprapubic puncture, and transurethral catheterization each have its own advantages and disadvantages, but the former is preferred for BPH patients. As for other patients, it all depends on specific conditions.