女性糖尿病合并膀胱颈梗阻的诊断和治疗(附25例报道)

Diagnosis and treatment of bladder neck obstruction in women with diabetes:A report of 25 cases

目的糖尿病合并膀胱颈梗阻女性患者经尿道膀胱颈电切术后膀胱功能的恢复及症状的改善很不理想,给患者带来极大的痛苦,文中探讨此类患者膀胱颈电切术后,应用溴吡斯的明联合盐酸阿夫唑嗪治疗的安全性及有效性。方法 25例女性糖尿病合并膀胱颈梗阻患者,10例(A组)膀胱颈电切术后予以口服盐酸阿夫唑嗪5 mg(2次/d);15例(B组)术后予以口服盐酸阿夫唑嗪5 mg(2次/d),联合溴吡斯的明60 mg(3次/d)。从排尿症状、尿动力学、B超、膀胱镜检查结果多个角度进行评估。结果 2组术前指标比较无统计学差异,术后IPSS、残余尿、排尿量、最大尿流率几组参数较术前均有统计学差异(P<0.05),术后3个月B组患者排尿困难症状和生存质量明显改善,术后6个月,临床效果明显改善达76%(19/25)。综合对比治疗后B组患者IPSS、Qmax、Pdet,残余尿等指标较A组更好,具有统计学差异(P<0.05),2组未观察到明显的毒副作用。结论女性糖尿病合并膀胱颈梗阻患者膀胱颈电切术后,溴吡斯的明联合盐酸阿夫唑嗪是一种安全而有效治疗选择。

Objective The effect of transurethral resection on the recovery of bladder function for the female diabetes patients with bladder neck obstruction is not ideal,which brings great pain to the patients.The effectiveness and safety of the combined therapy of pyridostigmine and alfuzosin hydrochloride after the treatment of transurethral resection of the bladder neck.Methods Total of 25 consecutive DM cases suffered from bladder neck obstruction were treated.After the resection of hinder margin on bladder neck,Inhibitor of receptor-α1（alfuzosin hydrochloride 5mg,bid） were given in the 10 patients.Otherwise,the treatment group included 15 patients who took alfuzosin hydrochloride（5mg,bid） and pyridostigmine（60mg.tid） in addition to the resection of hinder margin.A prospective study was performed from symptoms,urodynamics,B ultrasonic and cystoscope.For about or six months,all the exames were rechecked after the operation.Results All patients had both clinically and urodynamically confirmed,The symptoms and quality of life improved after three months,Clinical outcome was favorable in 76%（19/25） patients after six months,at baseline there were no significant differences between the groups,The results showed that the IPSS、PVR were significant decreased in the two groups（P0.05）,especially UPP（P0.01）,but the voiding volume and Qmax were elevated（P0.05）.There were significant difference between the groups for the Qmax、Pdet、PVR.No severe adverse effect was observed in the treatment group.Conclusion After the transurethral resection of the bladder neck,the combined therapy of pyridostigmine and alfuzosin hydrochloride is safe and effective.