经尿道尿道憩室切开术治疗成年女性尿道憩室的安全性和疗效  

Safety and efficacy of transurethral diverticulum section for treatment of adult female urethral diverticulum

作　　者：李嘉[1] 吴斌[1] 潘春雨[1] 刘先东[1] 孙明[1] 詹运洪[1] 白松[1] 

机构地区：[1]中国医科大学附属盛京医院泌尿外科,沈阳110004

出　　处：《中华泌尿外科杂志》2018年第1期45-48,共4页Chinese Journal of Urology

摘　　要：目的探讨经尿道尿道憩室切开术治疗女性尿道憩室的安全性及疗效。 方法回顾性分析2012年8月至2016年10月我院收治的11例女性尿道憩室患者的临床资料。年龄33～74岁，平均43岁。病史1个月～40年，平均80个月。主要症状包括尿痛、尿频、性交痛、会阴部坠胀感、反复尿路感染、排尿困难、尿后滴沥、尿不尽、阴道包块等。1例曾行经闭孔入路尿道中段悬吊术（TVT-O），2例有导尿史。查体均可于阴道前壁触及大小不等囊性包块，可有触痛及分泌物排出。影像学检查于尿道及阴道前壁之间见囊性占位。11例均全麻下行经尿道尿道憩室切开术。电切镜下采用针状电极，于憩室口垂直尿道长轴方向行环形切开，将憩室壁完全切开使其与尿道相通。11例均见尿道括约肌形态完整，阴道侧憩室壁完整、无损伤。术中均未损伤尿道括约肌，未出现尿道阴道瘘。记录手术时间、出血量、憩室位置、憩室数量等术中情况，以及术后症状缓解程度，术后短期及长期并发症等。 结果11例手术过程顺利，尿道憩室均完全敞开。手术时间30～45 min，平均35 min。术中出血量均〈5 ml。术中见4例为多发憩室，其中2例憩室口为2个，2例憩室口为3个；余7例为单发憩室，憩室口均为1个。术后留置尿管2周，拔除尿管后，患者排尿顺利，术前的症状消失。术后随访时间5～55个月，平均24个月。11例均未出现症状复发，无尿道狭窄、尿失禁、尿道阴道瘘等并发症。 结论经尿道尿道憩室切开术治疗女性尿道憩室安全可靠，疗效确切且无明显并发症。ObjectiveTo discuss the feasibility and the curative effect of transurethral diverticulum section in the treatment of female urethral diverticulum. MethodWe retrospectively analyzed the transurethral diverticulum section surgeries of 11 adult female patients diagnosed as urethral diverticulum in our hospital from August 2012 to October 2016.The patients aged from 33 years old to 74 years old with an average age of 43.Their medical histories varied from 1 month to more than 40 years with an average histories of 80 months. Major symptoms included odynuria, frequent micturition, dyspareunia, perineum bearing-down feeling, repetitive urinary tract infection, dysuria, urinary stuttering, penis masses, etc.One patient underwent TVT-O.Two patients had urinary catheterization before the disease.During physical examination, cystic masses of different sizes could be touched on anterior vaginal walls with pain and secretion.Cystic lesions can be found by imaging examination.Transurethral diverticulum section was performed under general anesthesia.Using needle electrode by resectoscope, we made an annular incision in the direction of the vertical axis of the urethra, from the beginning of diverticulum ostium. The diverticulum completely communicated with the urethra. In 11 patients of transurethral endoscopic, the urethral sphincter and the diverticulum wall appeared morphological integrity and no damage. There was no liquid drained to de vagina. There was no urethral sphincter injury and no urethral vaginal leakage. We observed the operation time, bleeding volume, diverticulum position, the number of diverticulum, urethral sphincter intraoperative. We also observed the postoperative symptoms, short-term and long-term complications. ResultAll surgeries went on well, in which urethral diverticula were fully opened. The operation time was 30-45 minutes, average 35 minutes. The amount of bleeding within 5 ml. 4 cases with multiple diverticulum, with 2 cases of diverticulum ostia were 2, 2 cases of diverticulum ostia were

关 键 词：女性 尿道憩室 经尿道 

分 类 号：R699.6[医药卫生—泌尿科学]