输尿管镜联合铥激光内切开术治疗尿道狭窄

Transurethral thulium laser urethrotomy for urethral stricture

目的：探讨输尿管镜联合铥激光内切开治疗尿道狭窄的疗效。方法：尿道狭窄或闭锁36例,采用输尿管镜联合铥激光行尿道内切开,汽化切除尿道瘢痕组织,恢复尿道的连续性,观察其临床疗效及并发症。结果：手术时间10~90 min,平均35 min,术后留置尿管2~6周后均排尿通畅,无尿失禁。随访4~24个月,平均12个月。27例患者无需尿道扩张,5例患者拔管后出现尿线变细,经定期尿道扩张后治愈,3例因未及时行尿道扩张需再次行尿道内切开术,1例行尿道狭窄段切除成形术。结论：输尿管镜联合铥激光行尿道内切开治疗短段尿道狭窄,安全有效,并发症少,住院时间短,亦可作为严重尿道狭窄、尿道闭锁的可选治疗手段,早期疗效良好,但远期效果尚待观察。

Objective： To evaluate the effect of endourethrotomy with thulium laser as a minimally invasive treatment for urethral stricture.Methods： We treated 36 cases of urethral stricture or atresia by endourethrotomy with thulium laser,restored the uretheral continuity by vaporization excision of the scar tissue,and observed the clinical effects and complications.Results： The mean operation time was 35 min,ranging from 10 to 90 min.Smooth urination was achieved after 2-6 weeks of catheter indwelling,with no urinary incontinence.The patients were followed up for 4-24（mean 12） months,during which 27 did not need any reintervention,5 developed urinary thinning but cured by urethral dilation,3 received another laser urethrotomy for previous negligence of timely urethral dilation,and the other 1 underwent open urethroplasty.Conclusion： Thulium laser urethrotomy is a safe and effective minimally invasive option for short urethral stricture,which is also suitable for severe urethral stricture and urethral atresia.Its short-term outcome is satisfactory,but its long-term effect remains to be further observed.