女性原发性膀胱颈部梗阻的诊治体会..docVIP

女性原发性膀胱颈部梗阻的诊治体会 】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;2 8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? 1 00ml，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 DiagnosisandTre atmentofPrimaryBla dderNeckObstructioninWomen Abstract： 0bjectiveToimprove thediagnosisandtre atmentofprimarybla ddernechobstructio nininfemalepation. Methods34caseswere include,withameana geof57yearsandsymp tomslastinganavera geofyears. Thediagn osisoffeamalebladd ernechobstructionw asbasedmainlyoncli nicalsymptoms,ruod ynamicsandcystosco py,supplementedwit himagingstudiesand laboratorytests. Fo rpatientswhosedetr usorpressurewasnor malormildlyincreas ed, a blockerwasused ； andforpatientswho failedtorespondtom edicaltreatmentorw hoseposteriorlipso fthebladderneckbec ameelevated,rigida ndnarrowedwi thves i caltrabeculaandcel laformation,transu rethralresectionof thebladderneckwasp erformed. ResultsTr eatmentwith a blocke rwaseffectivein6ca ses(%)，allhadinter nalsphincterthe28c aseswhohadbladdern eckfibrosisandcont racture,andtreated withtransurethralr esectionofthebladd erneck,27cases(%)h adimprovementinvoi dingfunction；lhadt otakemedicineforst rengtheningbladder rosis,hyperplasiao hem,and25cases(90% hronicinflammationa,submucosaandmeanrevealedlEiomyofibfthebladderneckint )hadconcomitantlyc sinvadingintomucospeakflowrate(Qmax)wasml/s(range，/s rengtheningbladder rosis,hyperplasiao hem,and25cases(90% hronicinflammation a,submucosaandmean revealedlEiomyofib fthebladderneckint )hadconcomitantlyc sinvadingintomucos peakflowrate(Qmax) wasml/s(range，/s 1/s),meanvoidingvo lumewas385ml(range eanresidualurinevo ,220ml 460ml),andm lumewas28ml(range, 12ml 10