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題名 | Relationships of Maximal Flow Rate, Residual Urine and Bladder Function in Prostatic Obstruction=前列腺阻塞病人最大尿流速、殘尿量與膀胱功能之關係 |
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作者姓名(中文) | 郭漢崇; 蔡崇璋; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 21:2 1988.03[民77.03] |
頁次 | 頁165-173 |
分類號 | 416.275 |
關鍵詞 | 前列腺阻塞; 最大尿流速; 殘尿量; 膀胱功能; |
語文 | 英文(English) |
中文摘要 | 對70位初步診斷為前列腺阻塞之病人進行動態壓力/尿流研究後,證實其中18位(26%)為非阻塞型,52位(74%)為阻塞型。我們再依最大排尿壓力及膀胱道尿肌之穩定性各分為兩個子群,以探討最大尿流速(Qmax),殘尿量與膀胱功能之關係。並以修正後之Qmax(Qmax/√volume)同時進行研究。 18位非阻塞病人平均Qmax為18.2±4.1 ml/sec,修正之Qmax為0.96±0.22,均大於阻塞型病人。在後者我們也發現膀胱壓力大小及膀胱穩定性與Qmax無關。但對於修正之Qmax,不穩定性膀胱較穩定性膀胱為高。以修正之Qmax進行比較較能代表真正膀胱作功量,也較不受排尿量大小之影響。 殘尿量與Qmax及修正之Qmax均呈負性相關(r=-0.4275,p<0.01;r=-0.4672,p<0.01),顯示Qmax愈大,殘尿量愈小。殘尿量在不同膀胱排尿壓力或不同穩定性之膀胱均無顯著差異。但如與尿道阻力指數(Rmin)共同研究,可發現殘尿量與Rmin成正相攔住(r=0.6291,p<0.01)。亦卽Rmin愈大,殘尿愈多,但與膀胱內壓大小無關。但是若將尿道阻力分為輕度阻塞(0.5<Rmin<1.0)與重度阻塞(Rmin>1.0),再分析其殘尿量,則發現非阻塞型與輕度阻塞型之殘尿量無顯著差異,但二者皆與重度阻塞群有意義之差異。尿道阻力增加時膀胱壓力也會增高,因此推論,在經度阻塞時,若有代償性之壓力增高可以使殘尿量減少。但是在重度阻塞時,縱有再高之代償性高壓亦屬無效。 我們的結論是最大尿流速與殘尿量雖可作為鑑別前列腺阻塞之參考,但並不能完全反應真正之阻塞程度以及膀胱功能之變化。最大尿流速與殘尿量成負相關,兩者又受尿道阻力影響最大。膀胱壓力的高低與最大尿流速無關,但與殘尿量在輕度阻塞時有相關。如果由最大尿流速或殘尿量均無法正確推斷病人有無前列腺阻塞,詳細的動態壓力/尿流研究仍是十分重要的檢查。 |
英文摘要 | Urinary flowmetry and residual urine were obtained from 70 males suspected to have prostatic obstruction. After pressure flow study, 18 (26%) were proved urodynamically unobstructed and 52 (74%) were obstructed. A correlation between bladder function and maximal flow rate (Qmax) and residual urine was thus made. Qmax in the unobstructed group was 18.2±4.1 ml/sec, much higher than in the obstructed group. In the obstructed group, there was no significant difference in Qmax between high pressure and low pressure groups, nor between stable and unstable groups. However, the corrected Qmax was higher in unstable bladders than in the stabie. Residual urine showed significant correlation with Qmax and corrected Qmax (P<0.01), a non-significant difference between high voiding pressure and low voiding pressure groups (P>0.05), and non-significant difference between stable and unstable groups (P>0.2). A good, statistically significant correlation between residual urine and minimal urethral resistance was also found (r=0.6291, P<0.01). Qmax is a good indicator of prostatic obstruction and is related mainly to the degree of urethral obstruction rather than the detrusor compensatory power. Urethral resistance contributes more to the formation of residual urine than detrusor contractility, especially in severely obstructed cases. However, in cases with mild obstruction, sustained detrusor contractility still plays an important role for residual urine. |
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