- 學位論文
以超音波檢測膀胱厚度預測婦女膀胱出口阻塞
Predicting Female Bladder Outlet Obstruction by Ultrasound Assessment of Bladder Wall Thickness
摘要
背景：膀胱出口阻塞在男性患者中相對的是比較常見的泌尿系統問題，然而對女性患者而言，往往成為被忽略的疾病。女性往往呈現儲尿症狀，而非排尿症狀。尿路動力學中的壓力尿流研究是膀胱出口阻塞的標準診斷工具，但此為侵入性檢查、操作費時且易造成患者心理壓力。用超音波測量膀胱壁的厚度已被證明是一種替代工具可用來診斷男性膀胱出口阻塞。本研究的目的是探討以超音波聲測量膀胱壁厚度來診斷女性患者膀胱出口阻塞的可行性。方法：針對收錄的172名女性患者，以自動測量超音波儀BVM9500來進行尿路動力學檢查之同時測量膀胱壁的厚度。已接受治療、神經性疾病，老年癡呆症，膀胱惡性腫瘤的患者則已先被排除在研究之外。我們分析膀胱壁厚度與尿路動力學檢查之數據是否有相關。使用統計軟體（SPSS17.0，SPSS Inc.，Chicago，IL，U.S.A）進行統計層次分析。結果：膀胱壁厚度在膀胱出口阻塞組較高，且有統計學上的差異。但以Spearman相關係數顯示，膀胱壁厚度和尿動力學結果並無顯著相關。ROC分析顯示，以膀胱壁厚度診斷出口阻塞僅有較低預測值，曲線下面積為0.616（95％CI為0.531-0.701）。結論：相對於男性的情況，膀胱壁厚度和婦女膀胱出口阻塞似乎沒有緊密相關。因此，以超音波測量膀胱壁厚度並不適於作為女性膀胱出口阻塞的診斷工具。
並列摘要
Background: Bladder outlet obstruction (BOO) is the most common urologic problem among the elder men, but this diagnosis is usually overlooked in females. The gold standard for diagnosing of BOO is pressure flow urodynamic studies (PFS) but patients will suffer from invasive procedure, time consuming and psychological stress. Ultrasonic measurement of bladder wall thickness (BWT) had been proven to be an alternative tool for diagnosing BOO in males. The aim of this study is to investigate the feasibility of ultrasonic measurement of BWT for evaluation of BOO in female population.Materials and Methods: Bladder wall thickness was measured by automatic ultrasound BVM9500 at the time of strong urge in 172 women undergoing PFS for lower urinary tract symptoms(LUTS). All patients with prior treatment for LUTS and those with underlying neurological disorders, dementia or bladder malignancy were excluded from analysis. BWT was correlated with PFS data.Obstruction was defined according to two different inspectors on the results of PFS. Statistical analysis was carried out by using the statistical software (SPSS 17.0; SPSS Inc., Chicago, IL, USA).Results: BWT was significantly higher (p=0.016) in BOO group 47cases,(BWT 2.29+/-0.518 mm) compared to non-BOO group (125 cases, BWT 2.08+/-0.506mm) . A weak Spearman correlation was found between BWT and PFS parameters. For a diagnosis of BOO, BWT of 1.95 mm or greater had a specificity of 47.5% and sensitivity of 72.2%. ROC analysis revealed that BWT had a lower predictive value for BOO with an AUC of 0.616 (95% CI 0.531–0.701).Conclusion: Contrary to the situation in men, increased BWT in women does not seem to be strongly correlated with BOO. Therefore, BWT cannot be used as a predictor of BOO women.