摘要目的 探讨腹腔镜改良膀胱颈Y-V成形术治疗前列腺增生术后复发性膀胱出口梗阻的临床效果.方法 回顾性分析2017年5月至2019年1月我院采用腹腔镜改良膀胱颈Y-V成形术治疗的17例前列腺增生术后复发性膀胱出口梗阻患者的临床资料.中位年龄71岁(65 ～ 81岁).所有患者均有反复排尿梗阻及尿路感染史,均行≥2次经尿道狭窄段内切开或电切术,并反复行尿道扩张治疗.17例中12例为膀胱颈狭窄(Ⅰ型),5例为前列腺中部狭窄(Ⅱ型).采用3孔法腹膜外径路进入Retzius间隙,显露膀胱与前列腺交界后倒“Y”形切开膀胱及狭窄段前列腺尿道,用2根3-0Statifix线分2层、对称、倒“V”形改良连续缝合切口,第1层缝合黏膜层及浅肌层,第2层缝合深肌层及浆膜层.术后留置F22硅胶导尿管2周,术后2周及3个月分别行尿流率和膀胱尿道镜检查评估手术效果.结果 17例手术均顺利完成,中位手术时间100 min(30～ 100 min),术中中位失血量50m1(20 ～100 ml),中位住院时间5 d(1 ～7 d).患者拔除导尿管后排尿通畅,无尿失禁.术后中位随访7个月(3～17个月),无尿道狭窄复发.结论 腹腔镜改良膀胱颈Y-V成形术治疗前列腺增生术后复发性膀胱出口梗阻,具有成功率高、复发率低、微创等优点.

abstractsObjective To investigate the clinical effect of laparoscopic modified bladder neck Y-V plasty in the treatment of recurrent bladder outlet obstruction after surgery for prostatic hyperplasia.Methods Seventeen patients with recurrent bladder outlet obstruction after prostatic hyperplasia operation from May 2017 to January 2019 was treated by laparoscopic bladder neck Y-V plasty,with the median age of 71 years old (65-81 years).All had a history of repeated urination obstruction and urinary tract infection,and experienced at least 2 times transurethral stenosis incision,resection or repeated urethral dilatation,with 12 cases of bladder neck stenosis (type Ⅰ) and 5 cases of middle prostate stenosis (type Ⅱ).Three-port laparoscopy surgery was performed with outer-peritoneal route into the Retzius Gap.After revealing the bladder and prostate junction,the "Y" incision of the bladder and stenosis of the prostate urethra was firstly performed,and inverted symmetrical "V" shape suture was performed with two 3-0 Stratifix suture for two layers,including the 1th layer suture of mucosal and inner muscle layer,and the 2nd layer suture of the outer muscle and the serous layer.F22 silicone catheter was indwelled for 2 weeks postoperatively.Urinary flow rate and bladder urethral examination were perfrmed to evaluate the effect of surgery 2 weeks and 3 months after the operation respectively.Results Seventeen operations were completed successfully,with the median operation time of 100 minutes (30-100 minutes),the median operation blood loss of 50 ml (20-100 ml),and the median hospital stay of 5 days (1-7 days).The patient had unobstructed voiding after removing the urinary catheter 2 weeks postoperatively,and had no urinary incontinence.Postoperative median follow-up was 7 months (3-17 months) and no stenosis of the urethra was detected.Conclusions Laparoscopic modified bladder neck Y-V Plasty has the advantages of high success rate,low recurrence rate and minimally invasiveness in the treatment of recurrent bladder outlet obstruction after prostatic hyperplasia surgery,which is worthy of clinical application.