经尿道膀胱颈内切开术治疗女性膀胱颈梗阻的疗效观察  

Transurethral resection of the bladder neck for female bladder neck obstruction

作　　者：陈延[1] 刘洪久[1] 肖永强[1] 苏世强[1] 李超[1] 张晋[1] 李珅[1] 庞书舰 

机构地区：[1]石家庄市第一医院泌尿外科,石家庄050011

出　　处：《临床泌尿外科杂志》2018年第2期160-162,共3页Journal of Clinical Urology

基　　金：石家庄市科学技术研究与发展指导计划项目(编号161460693)

摘　　要：目的:评估经尿道膀胱颈内切开术治疗女性原发性膀胱颈梗阻(PBNO)的长期疗效。方法:56例女性患者通过排泄性膀胱尿道造影及尿动力学检查确诊为PBNO,在膀胱颈上选取2点及10点位置,所有患者行经尿道膀胱颈内切开术。结果:术后随访6~72个月(平均26.2个月)。56例接受手术的患者中47例(83.9%)术后恢复良好,未见严重并发症。随访过程中,平均国际前列腺症状评分(IPSS)由21.2降至7.6(P<0.05),生活质量评分(QOL)由4.2降至2.3(P<0.05),最大尿流率(Q_(max))由8.63ml/s增至17.36ml/s(P<0.05),残余尿量(PVR)由106.32ml降至21.46ml(P<0.05),最大尿流率时逼尿肌压力(Pdet at Q_(max))由68.42cmH_2O降至19.86cmH_2O(1cmH_2O=0.098kPa,P<0.05)。术后出现的并发症有血尿、二次行膀胱颈内切开术、压力性尿失禁、尿道狭窄。所有这些并发症按Clavien分类评估为Ⅲa级。3例(5.3%)术后出现出血,经延长尿管留置时间、膀胱冲洗治愈,均未输血治疗;4例(7.1%)出现压力性尿失禁,行经阴道无张力尿道中段吊带术后恢复;4例(7.1%)出现尿道狭窄,间断尿道扩张后好转。结论:PBNO不常见,排泄性膀胱尿道造影及尿动力学检查可确诊,通过经尿道膀胱颈内切开术治疗安全有效。在膀胱颈的2点和10点方向仔细地、足够深度地行颈内切开可以保证手术的成功。Objective：To evaluate the long-term outcomes of bladder neck incision（BNI）for primary bladder neck obstruction in women.Method：Fifty-six women were diagnosed on the basis of excretory cystography and urodynamics study.BNI was performed for each patient,with incisions made at the 2-and 10-o＇clock positions on the bladder neck.Result：Follow-up data were available for 6-72 months（average,26.2）postoperatively.Successful recovery after BNI without serious complications was achieved in 47 of 56（83.9%）patients.During follow-up period,the mean International Prostate Symptom Score decreased from 21.2 to 7.6（P0.05）.Quality of life decreased from 4.2 to 2.3（P0.05）.The maximum uroflow rate increased from 8.63 ml/s to 17.36 ml/s（P0.05）.The postvoid residual decreased from 106.32 ml to 21.46 ml（P0.05）.The maximal detrusor pressure at the maximum uroflow rate decreased from 68.42 cmH_2O to 19.86 cmH_2O（1 cmH_2O=0.098 kPa,P0.05）.Several complications were identified after surgery including hematuresis,re-BNI,stress urinary incontinence（SUI）and urethral stricture.All these complications were gradeⅢa in the Clavien Classification of Surgical Complications.Three patients（5.3%）with secondary bleeding were cured by indwelling the urinary catheter and bladder irrigation without blood transfusion.Four patients（7.1%）experienced SUI and recovered after transvaginal tension-free vaginal tape-obturator.Four patients（7.1%）experienced urethral stricture after BNI and recovered after receiving intermittent urethral dilation.Conclusion：Primary bladder neck obstruction is uncommon and easily treatable when properly diagnosed by excretory cystography and urodynamics study.Careful,sufficiently deep incisions at the 2-and 10-o＇clock positions can ensure its success.

关 键 词：经尿道膀胱颈内切开术 膀胱颈梗阻 女性 

分 类 号：R694.2[医药卫生—泌尿科学]