女性膀胱颈梗阻诊治体会
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摘要
目的探讨女性膀胱颈梗阻的诊断标准和经尿道膀胱颈切开术的手术方法及治疗效果。方法回顾性总结分析我院2008年8月～2017年8月收治的57例女性膀胱颈梗阻病人的临床资料。结果依据尿动力学检查Q_(max)≤15mL/s,Pdet_(at max)≥20cm H_2O为膀胱颈梗阻的诊断标准,采用经尿道膀胱颈5、7点钟切开的手术方法,57例患者治疗效果良好,无尿瘘及尿失禁发生,术后患者临床症状好转,术前术后自由尿流率明显增高,患者膀胱残余尿量及上尿路积水量均显著减少。结论女性膀胱颈梗阻行尿流动力学检查对诊断具有重要意义,保留6点钟的经尿道膀胱颈5、7点切开术是治疗女性膀胱颈梗阻的有效治疗方法。
Objective To explore the diagnostic criteria of female bladder neck obstruction and the surgical method and therapeutic effect of urethral cystotomy. Methods The clinical data of 57 cases of female bladder neck obstruction in our hospital from August 2008 to August 2017 were reviewed retrospectively. Results According to the urodynamic examination,Q_(max) was no more than 15 mL/s,Pdet_(at max)≥ 20 cm H_2O was the diagnostic criteria for bladder neck obstruction,and the surgical method was performed by the urethral cyst at 5 and 7 o'clock,and 57 patients had good treatment effect.No urinary fistula and urinary incontinence occurred.The postoperative patients had better clinical symptoms.The free urinary flow rate was significantly increased after the operation,and the residual urine volume of the bladder was significantly reduced,and the volume of water in the patients with hydronephrosis was significantly reduced. Conclusion Urodynamic examination of female bladder neck obstruction is of great significance for diagnosis.Transurethral bladder neck incision at 5 and 7 o'clock at 6 o'clock is an effective treatment for female bladder neck obstruction.
Objective To explore the diagnostic criteria of female bladder neck obstruction and the surgical method and therapeutic effect of urethral cystotomy. Methods The clinical data of 57 cases of female bladder neck obstruction in our hospital from August 2008 to August 2017 were reviewed retrospectively. Results According to the urodynamic examination,Q_(max) was no more than 15 mL/s,Pdet_(at max)≥ 20 cm H_2O was the diagnostic criteria for bladder neck obstruction,and the surgical method was performed by the urethral cyst at 5 and 7 o'clock,and 57 patients had good treatment effect.No urinary fistula and urinary incontinence occurred.The postoperative patients had better clinical symptoms.The free urinary flow rate was significantly increased after the operation,and the residual urine volume of the bladder was significantly reduced,and the volume of water in the patients with hydronephrosis was significantly reduced. Conclusion Urodynamic examination of female bladder neck obstruction is of great significance for diagnosis.Transurethral bladder neck incision at 5 and 7 o'clock at 6 o'clock is an effective treatment for female bladder neck obstruction.
引文
[1]Patel R,Nitti V.Bladder outlet obstruction in women;drevalence recognition,and management[J].Curr Urol Rep,2001,2(5):379.
[2]Al-shahrani M,Lovatsis D.Do subjective symptoms of obstructive voiding correlate with post-void residual urine volume in women?[J]Int Urogynecol pelvic Floor Dysfunct,2005,16:12-14.
[3]Akikwala TV,Fleischman N,Nitti VW.Comparison of diagnostic criteria for female bladder outlet obstruction[J].Urol,2006,176(5):2093-2094.
[4]邓晓俊,郎根强,章益峰,等.女性膀胱颈抬高程度与膀胱出口梗阻相关性尿动力学分析[J]国际泌尿外科杂志,2011,31(4):442-445.
[5]郎建,闫晓州,周玉泉,等.女性膀胱颈口梗阻33例诊治分析[J].现代泌尿外科杂志,2012,17(5):495-496.
[6]周毅,邵宏祥.经尿道电切膀胱颈后唇治疗女性膀胱梗阻[J].临床泌尿外科杂志,2005,20(8):503-504.
[7]谢平,张旭,盛畅,等.女性膀胱颈硬化症手术前后尿动力学对照观察[J].中华医学杂志2011,91(46):3281-3283.
[8]王存华,刘成.经尿道汽化电切治疗女性膀胱颈梗阻临床分析[J].中国实用医刊,2010,37(24):63-64.
[9]石华,徐述雄,朱建国,等.输尿管导管引导下经尿道2μm激光膀胱颈切开术治疗女性膀胱颈梗阻[J].中华泌尿外科杂志,2013,34(6):479-480.
[10]胡其准,曾晓勇.经尿道膀胱颈电切术治疗女性膀胱颈梗阻21例分析[J].微创泌尿外科杂志,2014,1:52-53.
[11]Markic D,Maricic A,Oquic R,et al.Bladder neck incision for female bladder neck obstruction:long-term outcomes[J].Urology,2014,83(4):762-766.
[12]Markic D,Valencic M,Maricic A,et al.Transurethral bladder neck incision in women with primary bladder neck obstruction[J].Wien Klin Wochenschr,2014,126(7-8):217-222.
[13]Shen W,Ji H,Yang C,et al.Controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction:Description of a novel surgical procedure[J].Int J Urol,2016,23(6):491-495.
[14]Meier K,Padmanabhan P.Female bladder outlet obstruction:an update on diagnosis and management[J].Curr Opin Urol,2016,26(4):334-341.
[15]陈延,刘洪久,肖永强,等.经尿道膀胱颈内切开术治疗女性膀胱颈梗阻的疗效观察[J].临床泌尿外科杂志,2018,33(2):162-165.
[2]Al-shahrani M,Lovatsis D.Do subjective symptoms of obstructive voiding correlate with post-void residual urine volume in women?[J]Int Urogynecol pelvic Floor Dysfunct,2005,16:12-14.
[3]Akikwala TV,Fleischman N,Nitti VW.Comparison of diagnostic criteria for female bladder outlet obstruction[J].Urol,2006,176(5):2093-2094.
[4]邓晓俊,郎根强,章益峰,等.女性膀胱颈抬高程度与膀胱出口梗阻相关性尿动力学分析[J]国际泌尿外科杂志,2011,31(4):442-445.
[5]郎建,闫晓州,周玉泉,等.女性膀胱颈口梗阻33例诊治分析[J].现代泌尿外科杂志,2012,17(5):495-496.
[6]周毅,邵宏祥.经尿道电切膀胱颈后唇治疗女性膀胱梗阻[J].临床泌尿外科杂志,2005,20(8):503-504.
[7]谢平,张旭,盛畅,等.女性膀胱颈硬化症手术前后尿动力学对照观察[J].中华医学杂志2011,91(46):3281-3283.
[8]王存华,刘成.经尿道汽化电切治疗女性膀胱颈梗阻临床分析[J].中国实用医刊,2010,37(24):63-64.
[9]石华,徐述雄,朱建国,等.输尿管导管引导下经尿道2μm激光膀胱颈切开术治疗女性膀胱颈梗阻[J].中华泌尿外科杂志,2013,34(6):479-480.
[10]胡其准,曾晓勇.经尿道膀胱颈电切术治疗女性膀胱颈梗阻21例分析[J].微创泌尿外科杂志,2014,1:52-53.
[11]Markic D,Maricic A,Oquic R,et al.Bladder neck incision for female bladder neck obstruction:long-term outcomes[J].Urology,2014,83(4):762-766.
[12]Markic D,Valencic M,Maricic A,et al.Transurethral bladder neck incision in women with primary bladder neck obstruction[J].Wien Klin Wochenschr,2014,126(7-8):217-222.
[13]Shen W,Ji H,Yang C,et al.Controlled transurethral resection and incision of the bladder neck to treat female primary bladder neck obstruction:Description of a novel surgical procedure[J].Int J Urol,2016,23(6):491-495.
[14]Meier K,Padmanabhan P.Female bladder outlet obstruction:an update on diagnosis and management[J].Curr Opin Urol,2016,26(4):334-341.
[15]陈延,刘洪久,肖永强,等.经尿道膀胱颈内切开术治疗女性膀胱颈梗阻的疗效观察[J].临床泌尿外科杂志,2018,33(2):162-165.