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頁籤選單縮合
題名 | 逼尿肌無反射之尿滯留能否在前列腺手術後恢復排尿機能? |
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作者 | 郭漢崇; 張世忠; 許悌; | 書刊名 | 慈濟醫學 |
卷期 | 4:4 1992.12[民81.12] |
頁次 | 頁223-229 |
分類號 | 416.27 |
關鍵詞 | 手術; 尿; 前列腺; 排尿; 逼尿肌; 滯留; 機能; |
語文 | 中文(Chinese) |
中文摘要 | 在1988年7月至1992年5月間,在慈濟醫院580位連續接受前列腺手術的病 人中有46位同時具有尿滯留及逼尿肌無反射。其中33位接受經尿道前列腺切除 術,11位接受經尿道前列腺切開術,2位接受恥骨後前列腺切除術。我們在手術 後追蹤其排尿機能恢復情形,在追蹤6個月至4年後發現其中38位病人(83)能自行 排尿,8位(17)無法自行排尿,仍須依賴恥骨上膀胱造�略猻y。無法自行排尿者平 均年齡較大(77.9±6.2歲VS 72.8±7.2歲,P<0.05),但前列腺大小,膀胱最終灌注 壓力及上尿路變化對於能否恢復排尿機能均無預測價值。在38位排尿機能恢復的 病人中,有20位需要訓練超過14天,18位少於14天,平均是22.7±23.9天(範圍由3 至107天)。兩組病人在年齡、前列腺大小及最終灌注壓力統計上均無顯著差異。 共有12位病人有上尿路水腫,11位具有高最終灌注壓力,1位則為正常壓力 (P<0.05)。7位病人在恢復排尿機能使再度接受壓力/尿流研究,都可證明其逼尿肌 收縮力恢復,其中5位手術前具高最終壓力,2位具正常最終壓力。本研究結論為 當老年人發生尿滯留,不論其前列腺大小,手術以解決膀胱外阻塞是極恰當的治 療。當病人逼尿肌無反射時,手術中加上一條恥骨上膀胱造�畦H作為術後之膀胱 訓練是必須的,不論膀胱最終灌注壓力是高或正常,只要有足夠的時間使其逼尿 肌功能恢復,大部份的病人仍可恢復正常的排尿機能。(慈濟醫學 1992;4:223-229) |
英文摘要 | During the period between July 1988 and May 1992, 46 in 580 consecutive patients undergoing prostaticsurgeries for their urinary retention were noted to have detrusor areflexia preoperatively. Thirty-three patientsunderwent transurethral resection of the prostate (TURP), 11 underwent transurethral incision of the prostate(TUIP) and retropubic prostatectomy was performed in 2. In the follow-up period of 6 months to 4 years, 38patients (83) were able to void smoothly, while 8 (17) failed the bladder training and a suprapubic cystostomywas necessary for urinary diversion. The mean age was significantly higher in the patients failed the surgery(77.9±6.2 vs 72.8±7.2 years, P<0.05). However, there was no statistical significance in the prostatic size, endfilling pressure, bladder filling sensation nor in the upper tract deterioration with relevance to the prediction ofrecouery of voiding function. Among 38 patients able to urinate, 20 had to be trained for >14 days, 18 for <14days, with a mean of 22.7±23.9 days (range 3-107). There was also no statistical significance in age, prostaticsize or end-filling pressure between these two groups of patients. Upper tract deterioration was noted in 12patients, 11 with a high end-filling pressure and I with a normal pressure (P<0.05). Seven patients weredemonstrated to regain detrusor contractility on the second pressure flow study. Among them, 5 were highpressure and 2 were normal pressure preoperatively. This study concludes that prostatic surgery is the choice oftreatment in the elderly with urinary retention no matter there is a prominent prostatic adenoma or not. In caseof detrusor areflexia noted preoperatively, a suprapubic cystostomy is necessary for further bladder trainingafter surgery and expecting for the recovery of voiding function. A high percentage of patients, either with ahigh or normal end-filling pressure will eventually regain their detrusor contractility and voiding ability. (Tz'uChi Med J 1992; 4: 223-229) |
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