TURN结合膀胱颈部注射疗法治疗TURP术后膀胱颈挛缩

TURN combined with bladder neck injection for the bladder neck contracture after TURP

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 clinical value of TURN combined with bladder neck injection for the bladder neck contracture after TURP. Methods From March, 2006 to October 2009, TURN combined with bladder neck dexamethasone injection was given to 52 cases. The first injection was just after the TURN procedure, while another 3 injections were applied every 4 weeks under the cystoscope after the first administration. During the followup, the TURN combined with bladder injection was administrated repeatedly once a recurrence of the bladder neck contracture was found. Results The bladder neck elevation, bladder neck contracture, the bladder mucus ischemia and the soft tissue stiffness was recognized under the cystoscope. The pathologic examination revealed an important fibrosis and the lymphocyte infiltration was found in several cases. The urination came back to normal status in 41 cases（78.8%） and the peak flow was 15-22ml/s. The TURN and bladder neck injection was repeated in 8 cases（15.3%）, which leaded to a relatively satisfactory result with a peak flow from 10ml/s to 15ml/s. However, in 3 cases, the repeated TURN and bladder neck injection was failed with a peak flow〈 10ml/s and these cases received regular urethral dilation. Conclusion TURN combined with bladder neck injection remains an effective clinical management for the bladder neck stricture, even for the refractory bladder neck contracture.