【摘要】 目的提高女性膀胱颈部梗阻的诊治水平。方法总结107例患者,平均年龄59岁,病程平均2年8个月。诊断方法以临床症状、尿动力学和膀胱镜检查为主,辅以影像学和实验室检查。对膀胱镜检查显示膀胱颈后唇抬高、僵硬、狭窄伴膀胱内存在小梁小室者或膀胱颈部多发泡状水肿、绒毛状物者,行经尿道膀胱颈部电切术。结果该组107例均行经尿道膀胱颈部电切术,98例(91.7%)术后排尿症状明显改善,9例(8.3%)在手术后6～24周梗阻症状消失。切除的膀胱颈部组织病理报告为纤维平滑肌组织增生,均伴有慢性炎症。随访6～60个月,平均28个月,4例在术后2～4年膀胱颈部梗阻症状复发,再次经尿道膀胱颈部后唇切除治愈,最大尿流率和残余尿量明显改善。未发生尿失禁和尿瘘等并发症。结论经尿道电切术治疗女性膀胱颈部梗阻,手术操作简单,创伤小,出血少,疗效肯定。建议中度以上梗阻或经药物治疗效果不佳的轻度梗阻者应早期施行手术治疗。更多还原

【Abstract】 [Objective] To evaluate the methods of diagnosis and treatment of female bladder neck obstruction. [Methods] We reviewed 107 cases of female bladder neck obstruction from July 1996 to Dec 2006, whose age ranged from 24 to 83 years with a mean age of 59 years and symptoms lasting an average of 32 months. The diagnosis of female bladder neck obstruction was based mainly on clinical symptoms, urodynamics and cystoscopy, supplemented with imaging studies and laboratory test. For patients whose posteror lips of the bladder neck became elevated, rigid and narrowed with vesical trabecula and cella formation, or whose bladder neck showed blister-like edema, villous tumors, transurethral resection of the bladder neck was performed. [Results] Of the 107 cases, 98 cases (91.7%) had improvement in voiding function after transurethral resection of the bladder neck. The rest 9 cases (8.3%) obstruction symptoms were completely disappeared 6 to 24 weeks after operation. Pathology revealed leiomyofibrosis, hyperplasia of the bladder neck in them, and all cases had simultaneously chronic inflammations. The follow up time was 6 to 60 months and average 28 months, 4 cases recurrence was found bladder neck obstruction symptom 2 to 4 years after oparetion and they were cured by repeated transurethral resection of the bladder neck. Qmax and residual urine were improved significantly with satisfactory therapeutic effect. No incontinence of urine and fistula were noticed. [Conclusions] Transurethral resection of bladder neck is the best therapeutic option. Subjects with moderate degree of obstruction or with mild degree of obstruction and no effect treated by the drug therapy should be operated early.更多还原