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目的探讨经尿道膀胱颈部电切术(TURN)结合局部药物注射疗法在经尿道前列腺电切术(TURP)后膀胱颈挛缩治疗中的价值。方法 2006年3月至2009年10月共52例患者接受TURN加膀胱颈部注射地塞米松治疗。首次注射于TURN术后即刻进行,而后每4周行膀胱镜下膀胱颈部地塞米松注射治疗,共4次。随访过程中若膀胱颈部挛缩复发,则再次行TURN术结合定期膀胱颈部注射治疗。结果所有52例电切镜探查均见膀胱颈部抬高,颈口缩小,黏膜苍白,局部组织僵硬;TURN术后病理提示:纤维瘢痕组织增生,部分患者标本中可见慢性炎症表现伴淋巴细胞浸润。41例患者(78.8%)1次TURN结合定期注射治疗后,排尿恢复正常,尿流率15～22m1/s,8例患者(15.3%)重复手术结合定期注射治疗后,排尿基本满意,尿流率10～15ml/s,3例患者(5.9%)重复手术结合规律注射后,尿流率<10ml/s,目前仍维持定期尿道扩张。结论 TURN结合局部注射药物疗法是治疗TURP术后膀胱颈挛缩的有效疗法,对顽固性膀胱颈挛缩,也有一定的治疗效果。
Objective To investigate the value of transurethral resection of bladder neck (TURN) combined with local drug injection in bladder neck contracture after transurethral resection of the prostate (TURP). Methods From March 2006 to October 2009, 52 patients underwent TURN plus bladder neck dexamethasone. The first injection in TURN immediately after surgery, and then every 4 weeks cystoscopic bladder neck dexamethasone injection treatment, a total of 4 times. If the bladder neck contracture recurrence during follow-up, repeat TURN surgery combined with regular bladder neck injections. Results All 52 cases of resectable bladder neck were neck elevation, neck narrowing, mucosal pale, local tissue stiffness; TURN postoperative pathology: fibrous scar tissue hyperplasia, some patients showed chronic inflammation with lymphocyte infiltration . Urine flow rate was 15 ~ 22m1 / s in 1 patient (78.8%) after one TURN combined with regular injection. Urinary flow rate was 15 ~ 22m1 / s in 8 patients (15.3%) after repeat operation combined with regular injection. Rates of 10 ~ 15ml / s, 3 patients (5.9%) after repeated operation and regular injection, the urinary flow rate <10ml / s, is still maintaining regular urethral dilatation. Conclusion TURN combined with local injection therapy is an effective treatment for bladder neck contracture after TURP, and has a certain therapeutic effect on intractable bladder neck contracture.