多种腔镜技术联合治疗男性创伤性尿道狭窄

Application of multi-endoscopic technique in treatment of post-traumatic urethrostenosis in male patients

目的探讨多种腔镜技术联合治疗男性创伤性尿道狭窄的临床疗效和手术技巧。方法联合应用尿道镜冷刀切开、经尿道瘢痕电切和输尿管镜内切开技术治疗男性创伤性尿道狭窄47例，其中前尿道狭窄29例，后尿道狭窄18例，并对临床资料进行回顾性分析。结果43例腔内手术一次成功，1例第二次手术成功，术后排尿通畅，无尿失禁、尿瘘和再手术；3例后尿道狭窄腔内手术未获成功，改行耻骨上膀胱切开会师戳通尿道后用电切镜切除瘢痕，术后1例最大尿流率长期稳定在9～12ml／s，1例依赖尿道扩张维持排尿，1例不能排尿保留膀胱造瘘管。结论多种腔镜技术联合应用治疗男性创伤性尿道狭窄成功率高、安全性好，远期疗效稳定，值得推广应用。

Objective To study the clinical efficacy and operative skill of multi-endoscopic technique in treatment of post-traumatic urethrostenosis in male patients. Methods A retrospective analysis was done on clinical data of 47 male patients with post-traumatic urethrostenosis treated with direct visional incision urethrotomy combined with transurethral resection of sear tissue and ureteroscopic incision. There were 29 patients with anterior urethral strictures and 18 with posterior urethral strictures. Results Of all, 43 patients underwent successful endoscopic surgeries at the first time but one underwent secondary surgery because of unsuccessful endoscopic incision. These patients achieved satisfactory results without urinary incontinence, fistula or reoperation. The left three patients underwent open surgeries because of unsuccessful endoscopic incision, in which one patient could micturate at maximal flow rate of 9-12 ml/s, without therapeutic urethral dilation, one could mietnrate under regular therapeutic dilation and the other one could not micturate. Conclusions With the advantages of safety, high success rate and good long-term efficiency, multi-endoscopic technique can be used as an initial treatment for male patients with post-traumatic urethrostenosis and is worthy to be popularized.