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目的前瞻性研究“尿道关闭面积缩小术”(diminution of the ureathral functional area,DUFA)治疗女性原发性膀胱颈梗阻的疗效和并发症。方法 122例患者经尿动力学检查确诊为女性原发性膀胱颈梗阻,进行作者设计的新手术“尿道关闭面积缩小术”。统计手术持续时间、术中出血量。手术后随访6个月,统计分析国际前列腺症状评分(IPSS)、最大尿流率、残余尿量、尿道关闭面积、膀胱颈压、最大尿道压、膀胱逼尿肌压及并发症。结果 122例患者均得到随访,手术时间(19.7±8.3)min、出血量(15.2±6.9)m L。IPSS从术前25.6±8.2降为术后4.5±2.6,最大尿流率从术前(7.5±3.8)m L/s增加至(25.9±8.3)m L/s,残余尿量由术前(164.1±86.8)m L降为术后(17.4±9.1)m L,尿道关闭面积从术前(1 392.9±697.6)mmcm H_2O降为术后(654.6±211.3)mmcm H_2O,膀胱逼尿肌压从术前(36.5±12.1)cm H_2O降为术后(18.6±6.3)cm H_2O,膀胱颈压与最大尿道压降低。各项指标手术前后比较差异均有统计学意义(P<0.01)。并发症:术后2例大出血,3例轻微排尿困难,6例轻微压力性尿失禁,经保守治疗恢复。结论 DUFA既能有效解除尿道梗阻,显著提高尿流率,缓解患者症状,又不发生永久性尿失禁,并发症极少,是手术治疗女性原发性膀胱颈梗阻的安全而有效的手术术式。
Objective To prospectively study the efficacy and complications of diminution of the ureathral functional area (DUFA) in the treatment of female primary bladder neck obstruction. Methods One hundred and twenty-two patients were diagnosed as female primary bladder neck obstruction by urodynamic examination. A new operation designed by the author was performed. Statistics of surgical duration, intraoperative blood loss. The patients were followed up for 6 months after operation. The international Prostate Symptom Score (IPSS), maximal uroflow rate, residual urine volume, urethral closure area, bladder neck pressure, maximal urethral pressure, bladder detrusor pressure and complications were statistically analyzed. Results 122 patients were followed up, the operation time (19.7 ± 8.3) min, the amount of bleeding (15.2 ± 6.9) m L. IPSS decreased from 25.6 ± 8.2 preoperatively to 4.5 ± 2.6 postoperatively, and the maximum flow rate increased from 7.5 ± 3.8 m L / s to 25.9 ± 8.3 m L / s preoperatively 164.1 ± 86.8) m L to (17.4 ± 9.1) m L postoperatively, and the area of urethra closure decreased from (392.9 ± 697.6) mm cm H 2 O to (654.6 ± 211.3) mm cm H 2 O before surgery, Preoperative (36.5 ± 12.1) cm H_2O was reduced to (18.6 ± 6.3) cm H_2O, and the bladder neck pressure and maximum urethral pressure were decreased. The indexes before and after surgery were significantly different (P <0.01). Complications: 2 cases of postoperative bleeding, 3 cases of mild dysuria, 6 cases of mild stress urinary incontinence, after conservative treatment recovery. Conclusions DUFA can effectively relieve the urethral obstruction, significantly improve the urinary flow rate, alleviate the symptoms of patients without permanent urinary incontinence, with minimal complications. It is a safe and effective surgical procedure for surgical treatment of primary bladder neck obstruction in women .