原发性女性膀胱出口梗阻的手术疗效随访及其发病机制

doi:10.19723/j.issn.1671-167X.2019.06.013

摘要/Abstract

摘要：

目的观察经尿道膀胱颈切开术(transurethral resection of bladder neck, TURBN)对女性膀胱出口梗阻的手术疗效,研究原发性女性膀胱出口梗阻组织中性激素受体的表达。方法回顾性分析2008年10月至2013年12月因排尿困难入北京大学人民医院住院治疗并最终诊断为膀胱出口梗阻的40位女性患者的临床资料。膀胱出口梗阻定义为在排除神经源性疾病的前提下,尿动力学检查提示最大逼尿肌压大于25 cmH₂O(1 cmH₂O=0.098 kPa), 同时最大尿流率小于12 mL/s,通过膀胱镜检查最终确认诊断。对患者术前和术后的排尿期症状、储尿期症状、主观感觉进行问卷调查评分,观察相关的症状改善及并发症的发生情况。应用免疫组织化学评估测定女性膀胱颈的组织中性激素受体表达水平。结果 TURBN术后患者的储尿期症状评分、排尿期症状评分以及总评分均有明显改善(P<0.001)。1例患者术后出现了膀胱过度活动,4例患者术后出现了血尿,1例患者术后留置膀胱造瘘。有2例术前有充溢性尿失禁的患者术后症状得到改善,3例术前伴有膀胱过度活动症的患者术后症状得到改善,6例术前伴有肾积水的患者术后积水情况得到改善。患者对于手术的主观满意率为77.5% (31/40)。ER、PR、AR在正常膀胱颈和原发性膀胱出口梗阻(primary bladder neck obstruction, PBNO)患者组织中均有表达。PBNO的膀胱颈组织中,PR的阳性率显著低于正常对照组(P<0.05);中重度的PBNO患者3种性激素受体的阳性率与轻度患者差异无统计学意义(P>0.05)。结论经尿道膀胱颈切开对于治疗原发性女性膀胱出口梗阻有效,并发症相对较少。孕激素受体可能与女性PBNO的发生相关。

关键词: 膀胱出口梗阻, 经尿道膀胱颈切开, 女性性激素受体, 免疫组织化学

Abstract:

Objective: To investigate the effect of transurethral resection of bladder neck on primary female bladder neck obstruction and to analyze the expression of three kinds of sex hormone receptor (SR) in female bladder neck tissues diagnosed as primary bladder neck obstruction by the immunochemistry and statistics.Methods: The clinical data of 40 female patients, admitted into Peking University People’s Hospital for difficulty of voiding during Oct.2008 and Dec.2013 and eventually diagnosed as bladder outlet obstruction (BOO) by urodynamics, were retrospectively reviewed. BOO was defined as a maximum flow rate (Q_max) less than 12 mL/s together with a detrusor pressure at maximum flow rate (P_det Q_max) more than 25 cmH₂O in urodynamic study in the absence of neurological disorders. Diagnosis was confirmed by the cystoscopy. Preoperative and postoperative AUASS scores were recorded and analyzed for observation of curative effects and complications. The immunochemical expression of SR of primary female bladder neck obstruction (PBNO) tissues and normal control was examined and applied to statistical analysis.Results: There were significant changes postoperatively in voiding scores, storage scores and total scores (P<0.001). Postoperatively, 1 patient newly presented with overactive bladder (OAB), 4 patients newly presented with hematuria, and 1 patient underwent cystostomy. The symptoms of urinary retention with overflow incontinence in 2 patients disappeared after the surgery, and 3 patients complicated with OAB complained without urgency. In addition, pre-hydronephrosis improved postoperatively in six patients. The subjective satisfactory rate to the surgery of TURBN was 77.5% (31/40). Sex hormone receptor, including androgen receptor (AR), estrogen receptor (ER), progesterone receptor (PR), expressed in both bladder neck tissues of normal control and PBNO patients. In PBNO group, the expression of PR was significantly lower than that of control group (P<0.05), while the other 2 SRs expressed with no significantly statistical difference. PBNO patients were divided into 2 groups, according to their symptoms scores, and the expression of SRs showed no significant differences among the mild, moderate and severe groups (P>0.05).Conclusion: The transurethral bladder neck resection is valid in treating with female PBNO patients, with rarely occurrence of complications. PR expressed less in the female bladder neck tissues, and is possibly correlated with the occurrence of female PBNO.

Key words: Bladder neck obstruction, Transurethral resection of bladder neck, Sex hormone receptor, Immunohistochemistry

中图分类号:

R695.1

张晓鹏,张维宇,霍飞,胡浩,王起,许克新. 原发性女性膀胱出口梗阻的手术疗效随访及其发病机制[J]. 北京大学学报（医学版）, 2019, 51(6): 1052-1055.

Xiao-peng ZHANG,Wei-yu ZHANG,Fei HUO,Hao HU,Qi WANG,Ke-xin XU. Outcome of surgical management and pathogenesis of female primary bladder neck obstruction[J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1052-1055.

图/表 2

表1

图1

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Items	Before operation	After operation	P
AUAss storage phase	13.38±4.68	7.48±4.69	<0.001
AUAss urinating phase	11.85±3.92	5.95±3.40	<0.001
AUAss total score	25.22±7.47	13.42±4.99	<0.001
QoL	5.22±0.95	2.17±1.62	<0.001