女性原发性膀胱颈部梗阻的诊治体会_临床医学论文.docVIP

女性原发性膀胱颈部梗阻的诊治体会_临床医学论文 女性原发性膀胱颈部梗阻的诊治体会_临床医学论文 【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4.1 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220 ml～460 ml,平均385 ml,最大尿流率(Qmax)16.7 ml/s～25.4 ml/s,平均20.6 ml/s,剩余尿量12 ml～100 ml,平均28 ml。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 　　Diagnosis and Treatment of Primary Bladder Neck Obstruction in Women Abstract： Objective To improve the diagnosis and treatment of primary bladder nech obstructionin in female pation. Methods 34 cases were include, with a mean age of 57 years and symptoms lasting an average of 4.1 years. The diagnosis of feamale bladder nech obstructionwas based mainly on clinical symptoms, ruodynamics and cystoscopy , supplemented with imaging studies and laboratory tests. For patients whose detrusor pressure was normal or mildly increased ,α blocker was used;and for patients who failed to respond to medical treatment or whose posterior lips of the bladder neck became elevated,rigid and nar rowed with vesical trabecula and cella formation,transurethral resection of the bladder neck was performed. Results Treatment with α blocker was effective in 6 cases (17.4%),all had internal sphincter spasm.Of the 28 cases who had bladder neck fibrosis and contracture,and treated with transurethral resection of the bladder neck,27 cases (96.4%)had improvement in voiding function; 1 had to take medicine for strengthening bladder contractility.Pathology revealed leiomy of ibrosis,hyperplasia of the bladder neck in them,and 25 cases(90%) had concomitantly chronic inflammations invading intomucosa,submucosa and muscles.The mean peak flow rate (Qmax) was 20.6 ml/s (range,16.7ml/s～25.4 ml/s), mean voiding volume was 385 ml(range,220 ml～460 ml),and