经尿道膀胱颈切开术治疗女性原发性膀胱颈梗阻的效果分析  

Experience of transurethral incision of the bladder neck for female primary bladder neck obstruction

作　　者：张继伟[1] 王海涛[1] 何群[1] 王建军[1] 白焱[1] 夏溟[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院泌尿外科,100038

出　　处：《中华泌尿外科杂志》2016年第2期103-107,共5页Chinese Journal of Urology

摘　　要：目的：探讨经尿道膀胱颈切开术治疗女性原发性膀胱颈梗阻的治疗方法及效果。方法回顾性分析2004年1月至2013年12月收治的38例女性原发性膀胱颈梗阻患者的临床资料。年龄40～75岁，平均57．7岁。临床表现主要为不同程度的排尿困难，10例伴下腹部不适感，20例既往有泌尿系感染史。术前评估包括：体格检查、尿常规、国际前列腺症状评分（ IPSS）、生活质量评分（ QOL）、B超、尿动力学检查和尿道膀胱镜检查。本组患者尿动力学诊断标准为最大尿流率（Qmax）＜12 ml／s；最大尿流率时逼尿肌压力（Pdet．Qmax）＞20 cmH2O（1 cmH2O＝0．098 kPa）。38例患者术前均行α受体阻滞剂治疗3～6个月，无明显效果而行经尿道膀胱颈电切术。结果全部患者术后随访，随访时间12～60个月，平均29．6个月。术后33例症状改善，有效率为86．8％（33／38），2例术前合并双肾积水患者术后症状无改善，予永久膀胱穿刺造瘘；3例术后12～24个月再次手术，术后症状改善。术后12个月行IPSS评分、尿动力学检查进行术后疗效评估。术后IPSS评分（13．00±7．18）显著低于术前（26．63±3．15），差异有统计学意义（P＜0．01）；术后膀胱残余尿量（56．55±36．57）ml较术前（122．92±58．36）ml明显减少（P＜0．01）；术后Qmax（15．91±3．89）ml／s 明显高于术前（8．65±1．32）ml／s（P＜0．01）；术后Pdet．Qmax（36．12±4．74） cmH2O较术前（52．18±7．31） cmH2O显著下降（P＜0．01）。术后病理诊断：32例慢性炎症伴纤维组织增生，4例腺性膀胱炎，2例慢性炎症伴鳞状上皮化生。结论女性原发性膀胱颈梗阻的诊断主要依靠尿动力学及尿道膀胱镜检查，经尿道膀胱颈电切术是安全、有效的治疗手段。Objective To analyse and discuss the outcomes of female primary bladder neck obstruction（PBNO） with transurethral incision of the bladder neck（TUIBN）.Methods From January 2004 to December 2013, 38 female patients who underwent transurethral incision of the bladder neck were retrospectively reviewed.The mean age of patients was 57.7 years and the duration of symptoms before diagnosis was 3.5 years.All patients presented with varying degree of difficulty of urination.There were 10 cases with lower abdominal discomfort and 20 cases with history of urinary infection. Preoperative examinations included physical examination, urine routine, international prostate symptom score （ IPSS ） , quality of life （ QOL） , ultrasonography, urodynamics and cystoscopy.The urodynamic diagnostic criteria for PBNO were a maximum uroflow rate （ Qmax ） 〈12 ml/s, detrusor pressure during Qmax （ Pdet.Qmax ） ＆gt;20 cmH2 O.All patients failed with 3-6 month alpha-blockers treatment and then underwent TUIBN.Results Follow-up data of all patients were available for 12-60 months （ average 29.6） after operation.Successful recovery after operation was achieved in 33 of 38 （ 86.84 %） .At the first year follow-up, the IPSS decreased from 26.63 ±3.15 to 13.00 ±7.18 （P〈0.01）, the Qmax increased from （8.65 ±1.32） ml/s to （15.91 ±3.89） ml/s （P 〈0.01）, the postvoid residual decreased from （122.92 ±58.36） ml to （56.55 ±36.57） ml （P〈0.01）, and the Pdet.Qmax decreased from （52.18 ±7.31） cmH2O to （36.12 ± 4.74） cmH2O （P〈0.01）, respectively.Of the 5 cases in which the first operation was not successful, 3 cases （ 7.89%） underwent an additional TUIBN 1 to 2 years after the initial operation and 2 cases detected bilateral renal hydronephrosis by B-ultrasound before operation underwent life-long catheter cystostomy.The second operation of 3 cases was successful.Pathological examinations revealed fibrous tissue hyperplasia with chronic inflammation in 32 cases, glandu

关 键 词：膀胱颈梗阻 经尿道切开 排尿功能障碍 

分 类 号：R699.5[医药卫生—泌尿科学]