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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。
Objective To improve the diagnosis and treatment of female bladder neck obstruction. Methods Summary 107 patients, the average age of 59 years old, duration of an average of 2 years and 8 months. Diagnostic methods to clinical symptoms, urodynamic and cystoscopy, supplemented by imaging and laboratory tests. Cystoscopy showed that the posterior lip of the bladder neck was elevated, stiff, and stenosed with a presence of trabecular chamber in the bladder or multiple vesicular edema in the neck of the bladder, villi, and transurethral resection of the bladder neck. Results All the 107 cases underwent transurethral resection of the bladder neck. 98 cases (91.7%) had obvious voiding symptoms and 9 cases (8.3%) disappeared 6 to 24 weeks after operation. The resected bladder neck histopathology is reported as fibrous smooth muscle tissue hyperplasia, both with chronic inflammation. All the patients were followed up for 6 to 60 months with an average of 28 months. Four patients had recurrence of bladder neck obstruction 2 to 4 years after operation. The urethral bladder neck and posterior lip resection cured again, and the maximum urinary flow rate and residual urine volume were significantly improved. No complications such as urinary incontinence and urinary fistula occurred. Conclusion Transurethral resection of bladder neck obstruction in female patients with simple operation, less trauma, less bleeding, and definite therapeutic effect. It is recommended that patients with moderate obstruction or mild obstruction after poor drug treatment should be treated early surgery.