35例女性原发性膀胱颈部梗阻的临床分析

DIAGNOSIS AND TREATMENT OF PRIMARY BLADDER NECK OBSTRUCTION IN WOMEN OF 35 CESES

目的：提高女性原发性膀胱颈部梗阻的诊治水平。方法：35例患者，平均年龄59岁，病程平均4.1a。诊断方法以临床症状、尿动力学和膀胱镜检为主，辅以影像学和实验室检查。对逼尿肌压力正常或轻度升高者，行仅受体阻滞剂治疗；对药物治疗效果不佳、膀胱镜检示膀胱颈后唇抬高、僵硬、狭窄、膀胱小梁小室形成者，行经尿道膀胱颈部电切术。结果：本组6例（17．1％）仅受体阻滞剂治疗有效，均为内括约肌痉挛者；29例行经尿道膀胱颈部电切，均为膀胱颈部纤维化或挛缩者，其中27例（96．4％）术后排尿症状明显改善，1例加服增强膀胱收缩力的药物。切除组织病理报告为膀胱颈纤维平滑肌增生，25例（90％）合并慢性炎症。随访7～36个月，平均22个月，排尿量220～460mL，平均385mL，最大尿流率（Qmax）16．7～25．4mL／，平均20．6mL／s，剩余尿量12～100mL，平均28mL。结论：女性原发性膀胱颈部梗阻多由膀胱颈纤维化或平滑肌增生引起。对仅受体阻滞剂治疗无效并伴有膀胱颈部抬高或狭窄者，经尿道膀胱颈部电切术是一种安全而有效的治疗选择。

Objective：to improve the diagnosis and treatment of primary bladder neck obstruction in female patients . Methods：35 cases were included, with a mean age of 59 years and symptoms lasting an average of 4.1 years . the diagnosis of feamale bladder neck obstruction was based mainly on clinical symptoms, ruodynamies and cystoscopy , supplemented with imaging studies and laboratory tests for patients whose detrusor pressure was normal or mildly increased ,α blocker was used ; and for patients who failed to respond to medica ltreatment or whose posterior lips of the bladder neck became elevated, rigid and narrowed with vesical trabecula and celia formation, transurethral resection of the bladder neck was performed. Results：Treatment with α blocker was effective in 6 cases （17.1% ） ,all had internal sphincter spasm）. Of the 29 cases who had bladder neck fibrosis and contracture, and treated with transurethral resection of the bladder neck,27 cases （96.4%）had improvement in voiding function; 1 had to take medicine for strengthening bladder contractility. Pathology revealed leiomy of ibrosis, hyperplasia of the bladder neck in them, and 25 cases（90% ） had concomitantly chronic inflammations invading intomucosa, submucosa and muscles. The mean peak flow rate （Qmax） was 20.6mL/s （range, 16.7 -25.4mL/s）, mean voiding volume was 385mL（ range ,220 -460mL）, and mean residual urine volume was 28mL（ range, 12 - 100mL） during a mean follow up of 22 months （ range, 7 - 36months ）. Conclusion： Female bladder neck obstruction is primarily caused by leiomy of ibrosis, hyperplasia and chronic inflammations in the tissues surrounding the bladder neck. Transurethral resection of the bladder neck is safe and effective for the patients who fail to respond to α blocker and have elevated or contracted bladder neck.