尿道狭窄的腔内治疗(附56例报告)

Treatment of Urethral Stricture with Application of Endoscopic Technology(Report of 56 Cases)

目的:探讨尿道狭窄的腔内治疗效果。方法:对56例男性尿道狭窄患者联合采用尿道内冷刀及电切镜等腔内技术行尿道内切开术;对并发BPH、输尿管结石或膀胱肿瘤患者一并以电切镜或输尿管镜进行前列腺电切、气压弹道碎石或膀胱肿瘤电切术治疗。结果:本组56例尿道狭窄患者手术均一次成功,拔管后均排尿通畅,仅1例术后因出血而再次住院治疗;无明显尿失禁、尿瘘等并发症。术后根据狭窄段长度定期行尿道扩张。结论:采用经尿道腔内切开术、瘢痕电切术治疗尿道狭窄具有创伤小、并发症少等优点,避免了开放手术痛苦。为降低狭窄复发率,彻底切除瘢痕是必要的;为弥补瘢痕切除不彻底,狭窄段较长患者术后定期行尿道扩张也是必需的。同时,对于尿道狭窄合并BPH、输尿管结石或膀胱肿瘤的患者,在尿道狭窄处理后也可一并处理。

Objective：To evaluate the therapeutic efficacy of direct vision internal endoscopic technology as the treatment for urethral stricture. Methods：56 male patients with urethral stricture underwent internal urethrotomy using internal cold--knife combined with resectoscope. Patients with benign prostatic hyperplasia, urethral calculus or bladder tumor were treated with prostatic electrotomy, airpressure path macadam or bladder tumor electrot- omy. Results： All operations were succeeded primarily. All patients could void satisfactorily. Only one patient came back to hospital again because of bleeding. There was no complication such as incontinence or urinary fistula in all cases postoperatively. All patients were employed periodic urethral dilation according to the length of strictures postoperatively. Conclusions：Transurethral endoscopic incision combining scar electrotomy was a safe and efficient therapy which was miniinvasive and less complications for urethral stricture, and it avoided the pain of open surgery. In order to reduce the recurrence of stricture, the scar must be cut thoroughly, and periodic urethral sounding must be necessary if the scar was cut incompletely. Patients with benign prostatic hyperplasia, urethral calculus or bladder tumor can be treated after urethrotomy.