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1、女性原发性膀胱颈部梗阻的诊治体会【摘要】目的：提高女性原发性膀胱颈部梗阻的诊治水平。方法：34例患者,平均年龄57岁,平均病程4.1a。诊断方法以临床症状、尿动力学和膀胱镜检为主,辅以影像学和实验室检查。对逼尿肌压力正常或轻度升高者,行α受体阻滞剂治疗;对药物治疗效果不佳、膀胱镜检示膀胱颈后唇抬高、僵硬、狭窄、膀胱小梁小室形成者,行经尿道膀胱颈部电切术。结果：本组6例(17.4%)α受体阻滞剂治疗有效,均为内括约肌痉挛者;28例行经尿道膀胱颈部电切,均为膀胱颈部纤维化或挛缩者,其中27例(96.4%)术后排尿症
2、状明显改善,1例加服增强膀胱收缩力的药物。切除组织病理报告为膀胱颈纤维平滑肌增生，25例(90%)合并慢性炎症。随访7个月～36个月,平均22个月,排尿量220ml～460ml,平均385ml,最大尿流率(Qmax)16.7ml/s～25.4ml/s,平均20.6ml/s,剩余尿量12ml～100ml,平均28ml。结论:女性原发性膀胱颈部梗阻多由膀胱颈纤维化或平滑肌增生引起。对α受体阻滞剂治疗无效并伴有膀胱颈部抬高或狭窄者,经尿道膀胱颈部电切术是一种安全而有效的治疗选择。【关键词】膀胱颈梗阻女性治疗学 Dia
3、gnosisandTreatmentofPrimaryBladderNeckObstructioninWomen11Abstract：ObjectiveToimprovethediagnosisandtreatmentofprimarybladdernechobstructionininfemalepation.Methods34caseswereinclude,withameanageof57yearsandsymptomslastinganaverageof4.1years.Thediagnosisoffeam
4、alebladdernechobstructionwasbasedmainlyonclinicalsymptoms,ruodynamicsandcystoscopy,supplementedwithimagingstudiesandlaboratorytests.Forpatientswhosedetrusorpressurewasnormalormildlyincreased,αblockerwasused;andforpatientswhofailedtorespondtomedicaltreatmentorw
5、hoseposteriorlipsofthebladderneckbecameelevated,rigidandnarrowedwithvesicaltrabeculaandcellaformation,transurethralresectionofthebladderneckwasperformed.ResultsTreatmentwithαblockerwaseffectivein6cases(17.4%),allhadinternalsphincterspasm.Ofthe28caseswhohadblad
6、derneckfibrosisandcontracture,andtreatedwithtransurethralresectionofthebladderneck,27cases(96.4%)hadimprovementinvoidingfunction;1hadtotakemedicineforstrengtheningbladdercontractility.Pathologyrevealedleiomyofibrosis,hyperplasiaofthebladderneckinthem,and25case
7、s(90%)hadconcomitantlychronicinflammationsinvadingintomucosa,submucosaandmuscles.Themeanpeakflowrate(Qmax)was20.6ml/s(range,16.7ml/s～25.4ml/s),meanvoidingvolumewas38511ml(range,220ml～460ml),andmeanresidualurinevolumewas28ml(range,12ml～100ml)duringameanfollowup
8、of22months(range,7months～36months).ConclusionFemalebladderneckobstructionisprimarilycausedbyleiomyofibrosis,hyperplasiaandchronicinflammationsinthetissuessurroundingthebladderneck.
