经尿道前列腺电切术后膀胱颈挛缩原因分析及治疗措施

Cause analysis of bladder neck contracture after transurethral resection of prostate and therapeutic measures

目的探讨经尿道前列腺电切治疗良性前列腺增生术后发生膀胱颈挛缩(BNC)相关因素及治疗措施。方法回顾性分析2015年6月至2020年1月本院收治的1023例经尿道前列腺电切患者的临床资料,其中36例患者术后因排尿困难入院接受治疗(BNC组),膀胱镜下见膀胱颈黏膜苍白,膀胱颈后唇明显增高,膀胱颈呈环形狭窄,给予膀胱颈内切开联合颈部瘢痕切除治疗,定期复查及随访,明确排尿困难改善情况;另随机选取同期36例经尿道前列腺电切术后无BNC患者作为无BNC组,探讨经尿道前列腺电切术后致BNC相关因素及治疗措施。结果两组年龄、国际前列腺症状评分(IPSS)评分比较差异无统计学意义,两组前列腺体积、前列腺膀胱内突出度(IPP)、手术时间、留置尿管时间、前列腺特异性抗原(PSA)比较差异有统计学意义(P<0.05);术后1个月,BNC组Q_(max)、Q_(ave)均高于术前,残尿量少于术前,差异有统计学意义(P<0.05);术后6、12个月,BNC组Q_(max)、Q_(ave)及残尿量与术后1个月比较差异有统计学意义(P<0.05);术后6个月与术后12个月,Q_(max)、Q_(ave)及残尿量比较差异无统计学意义。结论前列腺大小、前列腺突入膀胱内程度、手术时间及术者对电切的熟练程度是造成经尿道前列腺电切术后BNC的主要原因,经尿道膀胱颈内切开联合膀胱颈瘢痕切除是目前治疗BNC有效方法。

Objective To explore different factors and therapeutic measures of bladder neck contracture(BNC)after transurethral resection of prostate.Methods The clinical data of 1023 patients with transurethral resection of prostate from June 2015 to January 2020 in our hospital were analyzed retrospectively,36 patients were admitted to hospital againdue topostoperative dysuria(BNC group),Cystoscopy in these patients revealed that mucosa of bladder neck was pale,the posterior lip tissue of the bladder neck was significantly increasedand the bladder neck was annular stenosis.Those patients were treated through resecting bladder neck and bladder neck scar resection by urethral indwelling cystoscopy,adopt regular review and follow-up to understandthe changes of dysuria.At the same time,36 patients without BNC after transurethral resection of prostate(non-BNC group)were randomly selected for comparison to explore the related causes and treatment measures of bladder neck contracture after transurethral resection of prostate.Results Age and international prostatesymptom score(IPSS)score showed no statistical significance between the two groups,while prostate volume,intravesical protrusion of prostate(IPP),operation time,induration-urinary catheter time,and prostate-specific antigen(PSA)showed statistically significant differences between the two groups(P<0.05).One month after surgery,Q_(max) and Q_(ave) of the BNC group were higher than those before surgery,and residual urine volume was lower than before surgery,the differences were statistically significant(P<0.05).At 6 and 12 months after surgery,Q_(max),Q_(ave) and residual urine volume in the BNC group were significantly different from that at 1 month after surgery(P<0.05).There was no significant difference in Q_(max),Q_(ave) and residual urine volume between 6 months and 12 months after surgery.Conclusion The size of the prostate,the degree of prostate protrusion into the bladder,the operation time and the proficiency of electrosurgical resection aremain causes of bladder neck contracture after transurethral resection of the prostate,transurethral bladder neck incision combined with bladder neck scar resection is an effective method to treat bladder neck contracture.