线型电刀电切术治疗男性尿道狭窄(附12例报告)

Treatment of male urethral stricture by linear electrotome resection(report of 12 cases)

目的探讨一种尿道狭窄的微创腔镜治疗方法。方法自2005年3月始至今,采用线型电刀行尿道瘢痕电切术治疗男性尿道狭窄12例,术后留置20F导尿管4周,拔除导尿管后定期行尿道扩张术4周～12个月,积极防治感染。结果12例均1次手术成功,手术成功率100%,术中出血极少,拔除导尿管后均排尿通畅,术后随访3～36个月,最大尿流率18～25mL/s,无尿道狭窄复发和尿失禁病例。结论线型电刀电切术治疗男性尿道狭窄,具有损伤小、效果佳、并发症少、手术操作简单、费用低等优点,是一种治疗尿道狭窄的微创腔镜治疗的新方法,对<2cm的尿道狭窄可能为首选的治疗方法之一。术中瘢痕的彻底切除和术后尿道定期扩张是预防再狭窄的重要手段。

[Objective] To investigate the efficacy and safety of endourology treatment for male urethral stricture and report our experience with the application of linear electrotome. [Methods] 12 patients were retrospectively reviewed who underwent linear electrotome from March 2005. After operation, all the patients were kept with 20 F Foley urethral catheter for 4 weeks. When urethral catheter was removed, dilation of urethra was done regularly for 4 weeks ~12 months to all the patients. And the infection must be prevented and cured. [Results] In all the patients, linear electrotome resection succeeded with less bleeding, and the suceess rate was 100% in this series. After urethral catheter was removed, all the patients voided smoothly. During 3 ~36 month follow-up, all the patients had no recurrence of the stricture and were satisfied with the quality of voiding. The maximum flow rate ranged from 18 to 25 mL/s. No patient had incontinence at last follow-up. [Conclusions] Linear electrotome is a safe and effective procedure for the treatment of male urethral stricture. The operative procedure is simple, safe, and effective. It is also assoeiated with less trauma, fewer complications. Therefore, it should be considered as the first line procedure for all the patients with urethral strictures less than 2 cm long. It is very important to prevent restricture by resetting sear completely and dilating urethra regularly.