腹腔镜膀胱颈Y-V成形术与经尿道膀胱颈电切治疗膀胱颈挛缩的比较

doi:10.3877/cma.j.issn.1674-3253.2024.04.015

目的

探讨腹腔镜膀胱颈Y-V成形术治疗前列腺增生（BPH）术后膀胱颈挛缩（BNC）的效果，并与经尿道膀胱颈电切术（TURBN）进行对比。

方法

回顾性分析联勤保障部队第990医院2019年1月至2022年3月采用腹腔镜膀胱颈Y-V成形术治疗的20例BNC病例资料，并与前期我院采用TURBN治疗的35例BNC病例资料做对比，以腹腔镜膀胱颈Y-V成形术作为观察组，TURBN组作为对照组。观察组首次出现BNC 16例为经尿道前列腺电切术（TURP）术后，4例为行经尿道前列腺激光切除术后；对照组首次出现BNC 28例为TURP术后，7例为经尿道激光前列腺切除术后。观察组和对照组BNC均接受过1次或1次以上经尿道膀胱颈电切或激光切开后再次复发。比较两组手术时间、术后24 h血红蛋白下降值、住院时间、留置尿管时间、术后6个月残余尿量（RUV）、国际前列腺症状评分（IPSS）、最大尿流率（Q_max）和复发情况。

结果

所有患者均顺利完成手术，观察组和对照组术后RUV和IPSS较术前均有显著下降（P<0.05），Q_max较术前均有显著提高（P<0.05）。观察组手术时间、住院时间、留置尿管时间均显著长于对照组（P<0.05），观察组术后RUV、IPSS显著低于对照组（P<0.05），Q_max显著高于对照组（P<0.05），两组的血红蛋白下降值差异无统计学意义（P>0.05）。术后随访6个月，观察组1例出现复发（5.00%），经2次尿道扩张后恢复，对照组复发10例（28.57%），两组比较差异有统计学意义（P<0.05）。

结论

腹腔镜膀胱颈Y-V成形术较TURBN术治疗BNC在改善RUV、IPSS和Q_max更有优势，复发率更低，是治疗复发性BNC的有效方法。

关键词: 腹腔镜, Y-V成形术, 膀胱颈挛缩, 经尿道膀胱颈电切术, 前列腺增生

Objective

To investigate the effect of laparoscopic Y-V cystoplasty on bladder neck contracture (BNC) after benign prostatic hyperplasia (BPH) and compare it with transurethral resection of bladder neck (TURBN).

Methods

The data of 20 cases of BNC treated by laparoscopic cystocervical Y-V plasty from January 2019 to March 2022 in 990th Hospital of Joint Support Force were analyzed retrospectively, and compared with the data of 35 cases of BNC treated by TURBN. The observation group was laparoscopic bladder neck Y-V plasty, and the control group was TURBN group. In the observation group, the BNC first occurred in 16 cases after TURP and 4 cases after transurethral laser prostatectomy. In the control group, 28 cases BNC first appeared after TURP and 7 cases after transurethral laser prostatectomy. BNC in the observation group and the control group recurred after one or more times of transurethral resection of bladder neck or laser incision. The operation time, the decrease value of hemoglobin 24 hours after operation, the hospitalization time and the indwelling time of urinary catheter, residual urine volume (RUV), international prostate symptom scale (IPSS), maximum urinary flow rate (Q_max), and recurrence 6 months after surgery were compared.

Results

All patients successfully completed the operation. RUV and IPSS in the observation group and the control group decreased significantly (P<0.05) and Q_max increased significantly (P<0.05). The operation time, hospitalization time and indwelling catheter time of the observation group were significantly longer than those of the control group (P<0.05). The RUV and IPSS of the observation group after operation were significantly lower than those of the control group (P<0.05), and Q_max was significantly higher than those of the control group (P<0.05). There was no significant difference in the decrease of hemoglobin between the two groups (P>0.05). Follow up for 6 months showed that 1 case in the observation group recurred (5.00%) and recovered after twice urethral dilatation, while 10 cases in the control group recurred (28.57%). There was significant difference between the two groups (P<0.05).

Conclusion

Laparoscopic bladder neck Y-V plasty is superior to TURBN in improving RUV, IPSS and Q_max, and has lower recurrence rate. It is an effective method to treat recurrent BNC.

Key words: Laparoscopy, Y-V plasty, Bladder neck contracture, Transurethral resection of bladder neck, BPH

表1 两组膀胱颈挛缩患者术前一般资料比较(

±s)

组别	例数	年龄(岁)	Q_max(ml/s)	IPSS(分)	RUV(ml)	BMI(kg/m²)
观察组	20	69±5	7.1±1.5	26.9±2.0	130±11	26.1±1.8
对照组	35	70±5	7.1±1.4	27.3±1.6	132±8	26.9±1.8
t值		0.818	0.165	0.847	0.675	1.682
P值		0.417	0.870	0.401	0.503	0.098

表1 两组膀胱颈挛缩患者术前一般资料比较(

±s)

组别	例数	年龄(岁)	Q_max(ml/s)	IPSS(分)	RUV(ml)	BMI(kg/m²)
观察组	20	69±5	7.1±1.5	26.9±2.0	130±11	26.1±1.8
对照组	35	70±5	7.1±1.4	27.3±1.6	132±8	26.9±1.8
t值		0.818	0.165	0.847	0.675	1.682
P值		0.417	0.870	0.401	0.503	0.098

图1　腹腔镜膀胱颈Y-V成形术治疗膀胱颈挛缩　图2　腹腔镜膀胱颈Y-V成形术后3个月膀胱镜复查结果注：1a为挛缩狭窄的膀胱颈，1b为Y形切开膀胱颈及尿道，1c为切开后的膀胱颈，1d为膀胱瓣和尿道缝合

表2 两组膀胱颈挛缩患者术后6个月资料比较

组别	例数	手术时间[min，(±s)]	血红蛋白下降值[g/L，(±s)]	住院时间[d，(±s)]	留置尿管时间[d，(±s)]	术后RUV[ml，(±s)]	术后IPSS[分，(±s)]	术后Q_max[ml/s，(±s)]	复发例数[例(%)]
观察组	20	75±10	1.8±0.7	8.7±1.0	14.2±0.5	20±3	6.2±1.1	20.4±1.6	1(5.00)
对照组	35	30±3	2.1±0.8	7.0±1.0	6.9±0.6	27±4	7.3±1.0	19.4±1.7	10(28.57)
统计值		t=24.157	t=1.418	t=5.912	t=46.426	t=6.930	t=3.740	t=2.084	χ²=4.420
P值		<0.001	0.162	<0.001	<0.001	<0.001	<0.001	0.042	0.036

表2 两组膀胱颈挛缩患者术后6个月资料比较

组别	例数	手术时间[min，(±s)]	血红蛋白下降值[g/L，(±s)]	住院时间[d，(±s)]	留置尿管时间[d，(±s)]	术后RUV[ml，(±s)]	术后IPSS[分，(±s)]	术后Q_max[ml/s，(±s)]	复发例数[例(%)]
观察组	20	75±10	1.8±0.7	8.7±1.0	14.2±0.5	20±3	6.2±1.1	20.4±1.6	1(5.00)
对照组	35	30±3	2.1±0.8	7.0±1.0	6.9±0.6	27±4	7.3±1.0	19.4±1.7	10(28.57)
统计值		t=24.157	t=1.418	t=5.912	t=46.426	t=6.930	t=3.740	t=2.084	χ²=4.420
P值		<0.001	0.162	<0.001	<0.001	<0.001	<0.001	0.042	0.036

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Comparison of laparoscopic bladder neck Y-V plasty versus transurethral resection of the bladder neck for bladder neck contracture

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Comparison of laparoscopic bladder neck Y-V plasty versus transurethral resection of the bladder neck for bladder neck contracture