经尿道膀胱颈电切治疗老年女性膀胱颈梗阻

目的提高对老年女性膀胱颈部梗阻的诊治水平。方法总结83例患者,平均年龄67岁,病程平均2年5个月。诊断方法为临床症状、尿流动力学、膀胱镜检查,影像学和实验室检查。膀胱镜检查显示膀胱颈后唇抬高、僵硬、狭窄伴膀胱内存在小梁小室者或膀胱颈部多发泡状水肿、绒毛状物者,行经尿道膀胱颈部电切术。结果该组83例均行经尿道膀胱颈部电切术,75例（90.4%）术后1周排尿症状明显改善,8例（9.6%）在手术后4～12周梗阻症状消失。切除的膀胱颈部病理报告为纤维平滑肌组织增生,均伴有慢性炎症。随访6～36个月,平均24个月,7例在术后2～4年膀胱颈部梗阻症状复发,再次经尿道膀胱颈部后唇切除治愈,最大尿流率和残余尿量明显改善。未发生尿失禁和尿瘘等并发症。结论经尿道电切术治疗老年女性膀胱颈部梗阻,手术操作简单,创伤小,出血少,疗效肯定。

Transurethral resection of bladder neck for the treatment of old female bladder neck obstruction

Objective To evdaluate the methods of diagnosis and treatment of old female bladder neck obsdtruction. Methods We reviewed 83 cases of old female bladder neck obstrucion from Jan 2000 to Dec 2007, whose age anged from 61 to 87 years with a mean age of 67 year and symptoms lasting an average of 29 months.The diagnosis of female bladder neck obstruction was based mainly on clinical symptoms,urodynamics and cystoscopy,supplemented with imaging studies and laboratory test,For patients whose posteror lips of the bladder neck became elevated ,rigid and narrowed with vesical trabecula and cella formation, or whose bladder neck showded blister-like edema, villous tumors, transurethral resectiom of the bladder neck was performed. Results Of the 83 cases, 75cases （90.4%） had improvement in voiding function after transurethral resection of the bladder neck. The rest 8 cases （9.6%） obstruction symptoms were completely disappeared 4 to 12 weeks after operation. Pathology revealed leiomyofibrosis,hyperplasia of the bladder neck in them, and all cases had simultaneously chronic imflammations. The follow up time was 6 to 36 months and average24 months,7cases recurrence was found bladder neck obstruction symptom 2 to 4 years after oparetion and they were cured by repeated transurethral resection of the bladder neck. Qmax and residual urine were improved significantly with satisfactory therapeutic effect. No incontinence of urine and fistula were noticed. Conclusions Transurethral resection of bladder neck is the best therapeutic option.