改良经尿道膀胱颈切开术治疗女性膀胱颈梗阻

Modified transurethral bladder neck incision in treatment of female bladder neck obstruction

目的探讨改良经尿道膀胱颈切开术治疗女性膀胱颈梗阻的疗效。方法选取北京市海淀医院2008年3月至2016年5月女性膀胱颈梗阻患者16例,均采用膀胱颈3、6和9点位置切开法的改良经尿道膀胱颈切开术治疗。分别于术前和术后1年行前列腺症状评分(IPSS)、生命质量评分(QOL)和最大尿流率(Qmax)评价。结果16例患者均手术顺利,平均手术时间20min,出血量<10ml,拔除尿管后排尿困难较术前明显改善。术后病理结果为慢性炎性改变伴纤维组织增生。所有患者术后均未发生尿失禁、膀胱阴道瘘、尿道狭窄等并发症。治疗后IPSS、QOL和Qmax均较治疗前明显改善[(6.43±3.31)分比(25.21±4.71)分、(1.41±1.15)分比(4.43±1.36)分和(15.36±4.82)ml/s比(7.49±2.27)ml/s],差异有统计学意义(P<0.01)。结论改良经尿道膀胱颈切开术治疗女性膀胱颈梗阻安全且有效。

Objective To evaluate the effect of modified transurethral bladder neck incision in treatment of female bladder neck obstruction. Methods Sixteen female patients with bladder neck obstruction from March 2008 to May 2016 in Beijing Haidian Hospital were selected, and the patients were treated with modified transurethral bladder neck incision at the 3, 6 and 9-O′clock positions. The international prostate symptom score (IPSS), quality of life (QOL) and maximum urinary flow rate (Qmax) were evaluated before surgery and 1 year after surgery respectively. Results All 16 patients underwent successful operation, and the mean operation duration was 20 min, with the blood loss<10 ml. The difficulty of urination after removing the catheter was significantly improved. Postoperative pathological results were chronic inflammatory changes with fibrous tissue proliferation. There was no complication such as urinary incontinence, vesico-vaginal fistula and urethral stricture after operation. The IPSS, QOL and Qmax after surgery were significantly improved compared with those before surgery:(6.43 ± 3.31) scores vs.(25.21 ± 4.71) scores,(1.41 ± 1.15) scores vs.(4.43 ± 1.36) scores and (15.36 ± 4.82) ml/s vs.(7.49 ± 2.27) ml/s, and there were statistical differences (P<0.01). Conclusions The modified transurethral bladder neck incision is a safe and effective therapy for female bladder neck obstruction.