女性原发性膀胱颈部梗阻的诊治体会.doc

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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a。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a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(%)a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(%)术后排尿症状明显改善，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

2、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)ml/s〜ml/s，平均ml/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a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DiagnosisandTreatmentofPrimaryBladderNeckObstructioninWomenAbstract：0bjectiveToimprovethediagnosisandtreatmen

3、tofprimarybladdernechobstructionininfemalepation.Methods34caseswereinclude,withameanageof57yearsandsymptomslastinganaverageofyears.Thediagnosisoffeamalebladdernechobstructionwasbasedmainlyonclinicalsymptoms,ruodynamicsandcystoscopy,supplementedwithimagingstudiesandlaboratorytests.Forpatientswhosede

4、trusorpressurewasnormalormildlyincreased,ablockerwasused；andforpatientswhofailedtorespondtomedicaltreatmentorwhoseposteriorlipsofthebladderneckbecameelevated,rigidandnarrowedwithvesicaltrabeculaandcellaformation,transurethralresectionofthebladderneckwasperformed.ResultsTreatmentwithablockerwaseffec

5、tivein6cases(%)，allhadinternalsphincterthe28caseswhohadbladderneckfibrosisandcontracture,andtreatedwithtransurethralresectionofthebladderneck,27cases(%)hadimprovementinvoidingfunction；lhadtotakemedicineforstrengtheningbladderrosis,hyperplasiaohem,and25cases(90%hronicinflammationa,submucosaandmeanre

6、vealedlEiomyofibfthebladderneckint)hadconcomitantlycsinvadingintomucospeakflowrate(Qmax)wasml/s(range，/s1/s),meanvoidingvolumewas385ml(rangeeanresidualurinevo,220ml460ml),andmlumewas28ml(range,12ml100ml)duringameanfollowupof22months(range,7months36months).Conclusckobstructionisprimyofibrosis,hyperp

7、1ammationsinthetisionFemalebladdernebladderresectionofmarilycausedbylEIolasiaandchronicinfsuessurroundingthethebladderneckissafeandeffectiveforthepatientswhofailtorespondtoablockerandhaveelevatedorcontracte