“尿道关闭面积缩小术”治疗女性膀胱颈梗阻的前瞻性研究  

A prospective study on diminution of ureathral functional area to treat female primary bladder neck obstruction

作　　者：张家华[1] 沈文浩[1] 包国华 季惠翔[1] 周远秀[1] 

机构地区：[1]第三军医大学西南医院泌尿外科,重庆400038 [2]杭州好克光电仪器有限公司,浙江杭州311200

出　　处：《第三军医大学学报》2016年第16期1877-1880,共4页Journal of Third Military Medical University

摘　　要：目的前瞻性研究"尿道关闭面积缩小术"(diminution of the ureathral functional area,DUFA)治疗女性原发性膀胱颈梗阻的疗效和并发症。方法 122例患者经尿动力学检查确诊为女性原发性膀胱颈梗阻,进行作者设计的新手术"尿道关闭面积缩小术"。统计手术持续时间、术中出血量。手术后随访6个月,统计分析国际前列腺症状评分(IPSS)、最大尿流率、残余尿量、尿道关闭面积、膀胱颈压、最大尿道压、膀胱逼尿肌压及并发症。结果 122例患者均得到随访,手术时间(19.7±8.3)min、出血量(15.2±6.9)m L。IPSS从术前25.6±8.2降为术后4.5±2.6,最大尿流率从术前(7.5±3.8)m L/s增加至(25.9±8.3)m L/s,残余尿量由术前(164.1±86.8)m L降为术后(17.4±9.1)m L,尿道关闭面积从术前(1 392.9±697.6)mmcm H_2O降为术后(654.6±211.3)mmcm H_2O,膀胱逼尿肌压从术前(36.5±12.1)cm H_2O降为术后(18.6±6.3)cm H_2O,膀胱颈压与最大尿道压降低。各项指标手术前后比较差异均有统计学意义(P<0.01)。并发症:术后2例大出血,3例轻微排尿困难,6例轻微压力性尿失禁,经保守治疗恢复。结论 DUFA既能有效解除尿道梗阻,显著提高尿流率,缓解患者症状,又不发生永久性尿失禁,并发症极少,是手术治疗女性原发性膀胱颈梗阻的安全而有效的手术术式。Objective To investigate the efficacy and complications of diminution of the ureathral functional area（ DUFA） in treating female primary bladder neck obstruction（ FPBNO）. Methods A total of122 patients,who were diagnosed with FPBNO by international prostate symptom score（ IPSS） evaluation and urodynamic examination,underwent surgical procedures in our institution from May 2009 to April 2015. The perioperative and follow-up data,including operative time,hemorrhage in operation,IPSS,maximum urine flow rate（ Qmax）,residual urine volume,ureathral functional area（ UFA）,detrusor muscle pressure and complications,were prospectively investigated. Results All of the operations were completed uneventfully.The median operative time was 19.7 ± 8.3 min（ ranged 16 ～ 27 min）. Hemorrhage in operation was 15.2 ±6.9 mL. Postoperative six-month follow-up data were available for 122 patients. The mean IPSS decreased from 25. 6 ± 8.2 to 4.5 ± 2.6. The Qmax increased from preoperative 7.5 ± 3.8 mL / s to postoperative 25. 9 ±8.3 mL / s. The mean residual urine volume was decreased from 164. 1 ± 86. 8 m L to 17. 4 ± 9. 1 m L. The mean UFA decreased from 1 392.9 ± 697.6 mmcm H_2O to 654.6 ± 211.3 mmcmH_2O. The mean detrusor muscle pressure decreased from 36.5 ± 12.1 cmH_2O to 18.6 ± 6. 3 cmH_2O. All the differences between the preoperative and postoperative values were significant（ P〈0.01）. Conclusion DUFA can decrease the UFA,release the obstruction and maintain the continence,so it is a safe and effective treatment method for FPBNO.

关 键 词：尿道关闭面积缩小术 女性 膀胱颈梗阻 

分 类 号：R694.3[医药卫生—泌尿科学] R695.1[医药卫生—外科学]