膀胱颈部电切联合曲安奈德注射治疗前列腺癌根治术后膀胱颈部挛缩疗效随访观察  

Follow-up and observation on the efficacy of bladder neck contracture after radical prostatectomy via transurethral resection of bladder neck combined with triamcinolone acetonide injection

作　　者：郑新宇 刘升[1] 张林琳[1] 贺大林[1] 杨林[1] ZHENG Xinyu;LIU Sheng;ZHANG Linlin;HE Dalin;YANG Lin(Department of Urology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院泌尿外科,陕西西安710061

出　　处：《现代泌尿外科杂志》2024年第6期492-496,500,共6页Journal of Modern Urology

基　　金：西安交通大学第一附属医院临床科研课题项目(No.XJTU1AFCRC2020SJ-022)。

摘　　要：目的分析应用膀胱颈部电切结合术中及术后规律曲安奈德注射治疗前列腺癌根治术(RP)后膀胱颈部挛缩(BNC)的有效性和安全性。方法回顾性分析2018年3月—2023年3月在西安交通大学第一附属医院泌尿外科接受膀胱颈部电切联合术中及术后规律曲安奈德注射治疗的19例RP后BNC患者的相关资料,分析患者术前、术后3、12个月及随访终点的国际前列腺症状评分(IPSS)、生活质量评分(QoL)的变化以及并发症发生情况。结果19例完成随访的患者中,有10例患者接受1次治疗;在治疗后复发的9例患者中,6例接受第2次治疗(其中2例术后再次复发),1例接受第3次治疗。平均随访3年,该方法1次成功率为52.6%(10/19),累计成功率为73.7%(14/19)。各随访时间点患者的IPSS、QoL均较术前明显改善(P<0.05)。19例随访患者术后并发症包括附睾炎2例(10.5%)、短暂性血尿2例(10.5%)、尿失禁11例(57.9%),其中新发尿失禁6例,5例尿失禁症状持续到随访终点。结论膀胱颈部电切结合术中及术后规律曲安奈德注射治疗RP后BNC有73.7%的成功率,但部分患者需多次手术,术后尿失禁发生率较高且恢复缓慢。Objective To analyze the efficacy and safety of transurethral resection of bladder neck combined with intraoperative and postoperative regular injection of triamcinolone acetonide in the treatment of bladder neck contracture(BNC)after radical prostatectomy(RP).Methods Clinical data of 19 patients with BNC after RP who underwent transurethral resection of bladder neck combined with intraoperative and postoperative regular triamcinolone acetonide treatment in our hospital during Mar.2018 and Mar.2023 were retrospectively analyzed.The changes in international prostate symptom score(IPSS),quality of life score(QoL)and complications were analyzed before operation,3 and 12 months after operation,and at the end of follow-up.Results All patients completed the follow-up,10 of whom received one treatment.Of the 9 patients with recurrence,6 received 2 treatments(including 2 cases of recurrence after surgery)and 1 received 3 treatments.After a mean follow-up of 3 years,the success rate of one treatment was 52.6%(10/19),and the cumulative success rate was 73.7%(14/19).The IPSS and QoL at each follow-up time point were significantly improved compared with those before surgery(P<0.05).Postoperative complications included epididymitis in 2 cases(10.5%),transient hematuria in 2 cases(10.5%),and urinary incontinence in 11 cases(57.9%),including 6 new cases of urinary incontinence,and 5 cases whose urinary incontinence lasted to the end of follow-up.Conclusion Bladder neck resection combined with intraoperative and postoperative regular triamcinolone acetonide injection has a successful rate of 73.7%in the treatment of BNC after RP.However,some patients require multiple operations,and the incidence of postoperative urinary incontinence is high and the recovery is slow.

关 键 词：膀胱颈部挛缩 前列腺癌根治术 膀胱颈部电切 曲安奈德 

分 类 号：R699.6[医药卫生—泌尿科学]