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研究生:廖瓊玲
研究生(外文):Chiung-Ling
論文名稱:膀胱出口阻塞合併頻尿症狀的尿道擴張治療評估
論文名稱(外文):The Effect of Urethral Dilatation in Bladder Outlet Obstruction Patients with Urinary Frequency
指導教授:周明智周明智引用關係
學位類別:碩士
校院名稱:中山醫學大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:58
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一、背景及目的
臨床門診之女性患者抱怨有下尿路症狀(Lower urinary tract symptoms)的困擾,其中又以頻尿(Frequency)症狀最多,可單獨或合併其他下泌尿症狀存在。我們必須針對此症狀背後所隱藏的真正病因,對症下藥去治療,才能使患者得到有效的症狀緩解。而尿路動力檢查(Urodynamic study)中的壓力尿流研究(Pressure-flow study)不僅可用來篩檢出具頻尿症狀的膀胱出口阻塞(Bladder outlet obstruction)患者,亦可作為日後治療的評估。本研究主要探討具有頻尿症狀的膀胱出口阻塞的個案接受尿道擴張(urethral dilatation)的治療,比較其治療效果及壓力尿流研究的治療前後變化及長期個案對於症狀改善的滿意度調查。並分析治療改善者的個案特質,做為將來臨床應用上治療成功的重要指標。
二、研究對象與方法
本研究自2005年1月1日至2006年6月30日間,收集中山醫學大學附設醫院婦產科一般門診固定單位就診的婦女;具有頻尿症狀者共162位,所有個案需接受骨盆檢查及尿液檢查及尿路動力學檢查。納入研究條件為尿路動力學檢查中發現解尿壓力(Pdet.Q max)≥35cmH2O,合併最大尿流速(Qmax)≤15ml/sec的個案診斷為膀胱出口阻塞。排除條件包括尿路感染、子宮脫垂二度以上,先前有實施尿失禁手術或子宮切除手術,神經性疾病、先前有注射Bulking agent,及曾有生殖泌尿道創傷的病歷史。將納入本研究的膀胱出口阻塞個案施以尿道擴張治療,治療後一個月回診接受尿路動力學檢查。尿道擴張術的Objective outcome是分析其治療前後排尿壓力的改善,最大尿流速的增加及尿容量的增加來評估。而治療的Subjective outcome是由個案陳述認為治療成功、改善或治療失敗。以SAS9.1的統計軟體分析治療後改善組及失敗組關於尿道擴張術治療前後其排尿壓力的改善、尿流速的增加及最大膀胱容量增加,並分析個案年齡、BMI、生產數及停經等個人特質與治療結果的相關性。
三、結果
所有31位接受尿道擴張術治療後的個案,其最大解尿壓力減少、最大尿流速增加及最大膀胱容量增加,都有統計上明顯差異,P值<0.05表示尿道擴張對所有個案都有顯著改善。有高達80.65%(25/31)的個案主觀認為治療成功或改善。
四、結論
本研究在排除條件後將收集的膀胱出口阻塞個案施以定期的尿道擴張,有80.65%的個案認為治療成功,我們認為尿道擴張對於經篩檢後膀胱出口阻塞患者有很大療效。我們分析個案特質,年紀愈輕、BMI愈小(<24),及生產數愈少(parity<3)者,其治療後的成功或改善率較高。至於停經婦女則建議在尿道擴張時,再加上賀爾蒙補充療法,療效會更加顯著。


Background and purpose:
Lower urinary tract symptoms are common in female patients at the Obs/Gyn clinics. Frequency, alone or combined with other symptoms, is the most often complaint of. We must understand the underlying mechanism of the symptoms to be able to treat effectively. Pressure-flow study for the urodynamic study serves not only as the tool for screening bladder outlet obstruction, but also as an evaluation tool after treatment. The purpose of this study is to evaluate the patients with bladder outlet obstruction complaining of frequency, who have undergone urethral dilation, to compare the urodynamic parameters of these patients before and after the procedure and to follow up the long-term subjective outcomes after treatment. We also analyzed the characteristics of the successful patients as important indices for future treatment effect.
Materials and methods:
We collected patients from a single Obs/Gyn clinic of Chung Shan medical university hospital from Jan. 1st, 2005 to Jun. 30th, 2006. Totally 162 women with the complaint of urinary frequency received pelvic examination, urinanalysis and urodynamic study. The patients diagnosed as bladder outlet obstruction with voiding pressure (Pdet-Qmax) ≧35 mm H2O and the maximum flow rate (Qmax) ≦15 ml/sec in the urodynamic study were included in this study. Exclusion criteria were urinary tract infection, pelvic prolapsed, previous anti-continence surgery or hysterectomy, neurogenic disease, previous injection with a bulking agent, and previous urogenital trauma. All the patients received urethral dilatation and urodynamic study was performed one month after the procedure. The objective outcomes were determined by the differences of voiding pressure, the maximal flow rate and bladder capacity before and after the procedure. The subjective outcome was determined by the satisfaction for quality of life by questionnaires. SAS 9.1 was used for statistic analysis.
Result:
31 patients entered this study. In all of them, the voiding pressure decreased, the flow rate increased and the bladder capacity increased significantly (p value &lt; 0.05) after urethral dilatation. 80.65% (25/31) patients were satisfied with the procedure by questionnaire.
Conclusion:
Urethral dilatation provides an effective solution for relief of urinary frequency in patients with bladder outlet obstruction. Our study suggests that patients who are younger, thinner (BMI &lt; 24), and less productive (parity &lt; 3) have better results of treatment. Additional hormone replacement therapy might be of benefit for postmenopausal women.


1.口試委員會審定書……………………………………… 1
2.中文摘要…………………………………………………6
3.英文摘要…………………………………………………9
4.第一章 緒論
第一節 研究背景與動機………………………………….12
第二節 研究目的………………………………………….14
5.第二章 文獻探討
第一節 下尿路症狀-頻尿…………………………………15
第二節 膀胱出口阻塞…………………………….………17
6.第三章 材料與方法
第一節 研究對象…………………………….……………25
第二節 研究設計、方法與程序………………………….27
第三節 統計分析法………………………………….…....29
7.第四章 結果………………………………….………………30
8.第五章 討論…………………………………….……………33
9.第六章 結論………………………………………………….37
10.參考文獻……………………………………………… ……..38
圖目錄
圖一 遠端尿道狹窄的尿路動力學檢查結果……………………45
表目錄
表1:婦女下尿路症之錄影尿動力學結果與症狀之關係…………46
表 2 女性膀胱出口阻塞的原因……………………………………46
表 3 膀胱出口阻塞的型態與治療方式……………………………47
表 4:研究個案的特質………………………………………………47
表 5:個案治療前後的尿路動力學檢查參數………………………48
表 6:個案治療前後的尿路動力學檢查各因子的改善比較………49
表 7:治療改善組及失敗組之尿路動力學檢查個因子的改善狀況..49
表 8:治療後改善組及失敗組的個案特質…………………………49
表 9:年齡對治療成效的影響………………………………………50
表 10:身體質量指數(BMI)與改善組及失敗組的關係……………50
表11:生產數對治療成效的影響……………………………………51
表12:停經(Menopause)對療效的影響………………………………51


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