经尿道膀胱颈环形电切术治疗女性原发性膀胱颈梗阻的效果分析

Transurethral Circular Incision for Primary Bladder Neck Obstruction in Women to Improve Voiding Function

评价经尿道膀胱颈环形电切术对女性原发性膀胱颈梗阻(PBNO)的治疗效果。33例女性经尿动力学诊断为女性PBNO,予以膀胱颈环形电切并参照术前膀胱颈超声重点电切膀胱颈的肥厚部位,经术前及术后的膀胱颈超声及尿动力学结果变化对比评估排尿效果。随访3个月~48个月,平均23个月。平均国际前列腺症状评分(IPSS)从27.1降到13.5,平均膀胱颈前、后唇厚度分别从9.8mm降到3.2mm及从8.3mm降到2.3mm,平均残余尿量(PVR)从123.2ml降到27.8ml,平均最大尿流率(Qmax)从6.5ml/s提高到20.4ml/s,平均最大尿流率时逼尿肌压力(Pdet,Qmax)由52.2cm H2O降到16.7cmH2O,差异均有统计学意义。参照术前超声提示的膀胱颈梗阻部位及厚度,采取膀胱颈环切及重点肥厚部位的电切方法治疗PBNO,能达到较为理想的排尿疗效。

To investigate the significance in transurethral circular incision for primary bladder neck obstruction（PBNO）in women to improve voiding function.33 female patients with PBNO diagnosed by urodynamic examination accepted transrectal ultrasonography to measure the thickness of anterior and posterior labium of bladder neck.All the patients accepted transurethral circular incision of bladder neck referring to the results of trans-rectal ultrasonography,and the obvious thick labiums were resected additionally.33 patients could urinate straining.There were significant difference in IPSS,the thickness of anterior and posterior labium of bladder neck,residual urine,Qmax and Pdet,Qmax between preoperation and postoperation.The average IPSS decreased from 27.1to 13.5.The average thickness of anterior labium of bladder neck decreased from 9.8mm to 3.2mm,and the thickness of posterior labium of bladder neck decreased from 8.3mm to 2.3mm.The the average residual urine decreased from 123.2ml to 27.8ml（P〈0.05）.The average Qmax increased from 123.2ml to 27.8ml.The average Pdet Qmax decreased from 52.2cmH2 O to 16.7cmH2 O.The method of transurethral circular incision of bladder neck referring to the results of trans-rectal ultrasonography is effective to improve voiding function in female PBNO.