铥激光尿道内切开治疗尿道狭窄及闭锁的疗效观察

Efficacy of transurethral 2 μm laser urethrotomy in the treatment of urethral stricture and atresia

目的 观察铥激光（2μm激光）尿道内切开治疗尿道狭窄及闭锁的疗效。方法 随访192例尿道狭窄或闭锁并经铥激光内切开治疗患者，测定术后拔尿管时、术后3个月及术后6个月最大尿流率（MTR）并与术前作统计学比较。结果 所有患者术后拔尿管时均能自主排尿，平均MFR（16．7±3．1）ml／8，与术前[（3．2±0．3）ml／s]比较差异均有统计学意义（均P〈0．01）。其中157例一次手术治愈，无复发；35例拔尿管后1～3周复发，经定期尿道扩张后全部能正常排尿；6例术后尿失禁患者经理疗及训练后恢复正常。所有患者术后3个月平均MTR（18．7±3．1）ml／s，术后6个月为（19．2±2．8）ml／s，与术前比较差异均有统计学意义（均P〈0．01）。结论 经尿道铥激光尿道狭窄内切开术是治疗尿道狭窄及闭锁的安全有效的方法。

Objective To evaluate the curative efficacy of transurethral 2 μm thulium laser urethrotomy in the treatment of urethral stricture and atresia. Methods 192 patients suffering from urethral stricture （n = 179） or atresia （ n = 13 ）, all male, aged 45.4 （ 38 - 56）, underwent transurethral 2μm thulium laser urethrotomy. The maximum flow rate （MFR） was measured before operation, immediately after removing the catheter, and 3 and 6 months postoperatively. Results All the patients got fluent urination immediately after the catheter removal with the mean MFR of （ 16.7±3.1 ） ml/s, significantly higher than that before the operation [ （ 3.2 ± 0.3 ） ml/s, P 〈 0. 01 ]. 157 patients got permanent fluent urination without recurrence; 35 patients got recurrence 1 to 3 weeks after the catheter removal and got final cure 3 months later after periodic urethra dilatation. Besides, 6 patients encountered incontinence and all finally got convalescence after physical therapy and exercise. The mean MFR of all the patients 3 months and 6 months postoperatively were （ 18.7 ±3.1 ） ml/s and （ 19.2 ± 2.8 ） ml/s respectively, both significantly higher than that before operation （ both P 〈 0.01 ）. Conclusion Transurethral 2 μm thulium laser urethrotomy is a safe and efficient method in the treatment of urethral stricture and atresia.