【摘要】 目的探讨1 470nm半导体激光经尿道膀胱颈切开术治疗女性膀胱颈梗阻的临床疗效。方法 2015年3月至2017年4月,我院采用1 470nm半导体激光行经尿道膀胱颈切开术治疗28例女性膀胱颈梗阻患者,其中6例为宫颈癌放疗后患者、22例为原发性膀胱颈梗阻患者。全部病例均于膀胱颈3点和9点切开,深达浆膜层;对于膀胱颈5～7点有明显抬高的病例,于5～7点切割至深肌层,使后尿道与膀胱三角区平齐。结果所有手术均顺利完成,平均手术时间(19.6±2.3)min。术后随访12个月。手术前后比较,平均最大尿流率由(7.66±2.15)ml/s增加至(20.47±1.57)ml/s,平均国际前列腺症状评分由(24.11±3.58)分下降至(5.36±0.91)分,平均生活质量评分由(4.96±0.79)分下降至(1.07±0.86)分,平均残余尿量由(97.61±62.65)ml下降至(9.48±3.57)ml,所有指标差异均有统计学意义(P<0.01)。结论 1 470nm半导体激光经尿道膀胱颈切开术治疗宫颈癌放疗后膀胱颈梗阻和女性原发性膀胱颈梗阻具有易于操作、创伤小、出血少、术后恢复快和疗效确切等优势;恰当的切割位置和深度是保证手术疗效和避免并发症的关键。更多还原

【Abstract】 Objective To present the clinical effects of transurethral incision of bladder neck(TUIBN)with 1 470 nm diode laser for the treatment of bladder neck obstruction in female patients.Methods A total of 28 female patients underwent TUIBN with 1 470 nm diode laser from March2015 to April 2017,6 of 28 patients underwent radiotherapy after radical hysterectomy of cervical cancer in the past,while 22 of them were diagnosed as primary bladder neck obstruction(PBNO).The bladder neck in all patients were incised at 3 and 9 o’clock until the serous layer,while those with significant elevation of bladder neck were first incised between the 5 and 7 o’clock to make sure the posterior urethra and the bladder triangle area were at the same level. Results All the operations were completed uneventfully,the median operation time was(19.6±2.3)min.Follow-up data of 28,27 and 25 patients was available in 1,6 and 12 months respectively.Compared with the preoperative data,the mean maximum urine flow rate increased from(7.66±2.15)ml/s to(20.47±1.57)ml/s,the mean International Prostate Syndrome Score decreased from(24.11±3.58)to(5.36±0.91),the mean Quality of Life Score decreased from(4.96±0.79)to(1.07±0.86),and the mean post-void residual decreased from(97.61±62.65)ml to(9.48±3.57)ml.All the data showed statistical significance(P<0.01). Conclusions The characteristics of TUIBN with 1 470 nm diode laser for bladder neck obstruction after radiotherapy of cervical cancer and PBNO in female patients include convenient operation,slight injury,less bleeding,rapid postoperative recovery and definite therapeutic effect.Appropriate incising sites and depth are the key points to ensure the operative effect and avoid the complications.更多还原