排尿功能障碍与上尿路损害 .doc

排尿功能障碍致上尿路损害216例临床分析 李 新，金锡御，宋 波，熊恩庆，方 强，樊汝惠 （第三军医大学西南医院全军泌尿外科研究所，重庆 400038） 摘要　目的：探讨排尿功能障碍致上尿路损害的致病机制。方法：对216例排尿功能障碍导致上尿路功能损害病例的尿动力学、泌尿影像学及肾脏功能学资料进行回顾，观察膀胱残余尿、膀胱压力和膀胱容量与上尿路损害之间的关系并进行分析。结果：在引起上尿路损害的216例患者中，膀胱出口梗阻是最主要的病变 89.4 %，185/207 ；部分患者（21.2%，43/216）残余尿量不多（ 50cmH2O），但已引起上尿路损害；70.1% 145/216 以上患者膀胱储尿期压力大于40cmH2O，初始尿意压力（47.4±3.2）cmH2O51.7±9.3）cmH2O cmH2O）之上，初始尿意容量（438.4±81.7） ml明显大于安全容量（357.9±73.3） ml。结论：40 cmH2O是上尿路损害的膀胱压安全临界值；达到或超过安全压仍继续储尿是上尿路损害的最重要原因；将膀胱压降至安全压以下以及在安全容量前排空膀胱是治疗和预防上尿路损害的重要措施。 关键词：排尿功能障碍；上尿路；尿动力学 Study on the mechanism of upper urinary damage due to voiding dysfunction.　 , Song Bo , et al. Institute of Urology of PLA, Southwestern Hospital, 3rd Military Medical University, Chongqing 400038 , China Abstract　Objective To clarify the urodynamic mechanism of due to voiding dysfunction. 　Methods The medical history radiographic studies and urodynamic results from 216 patients with voiding dysfunction who were treated at our hospital were reviewed retrospectively. The upper urinary tracts were assessed by type-B ultrasonic　and excretory urography to determine the incidence of hydronephrosis. The relationships between the urodynamic variables, including residual urine, vesical pressures to such upper tract deterioration were evaluated using both univariate and multiple logistic regression analysis. Results Bladder outlet obstructure 89.4%,n 185 was the main pathologic change in 216 patients. Upper urinary tract damage had been occurred in patients with lower residual urine（ 50cmH2O）. The vesical pressures in 70.1% n 145 of patients are higher than 40cmH2O . The　average volume（438.4±81.7）ml at the first desire to voiding is higher than that of safty volume（357.9±73.3）ml, which means it will damage to upper urinary tract.　Conclusion ydronephrosis caused by voiding dysfunction. Keeping bladder filling after the safty pressure is the cardinal risk factor for hydronephrosis. To keep the vesical pressure under safety value and voiding before safety volum