直视下输尿管镜联合筋膜扩张器在尿道狭窄中的临床应用

The clinical application of direct vision under ureterscope combined with fascia dilator in urethrostenosis

目的探讨直视下输尿管镜联合筋膜扩张器在经常规金属尿道探子扩张失败男性尿道狭窄治疗中的临床应用。方法对42例各种原因引起的尿道狭窄经常规金属尿道探子扩张失败的患者,腰麻下用F8/9.8输尿管镜检查尿道狭窄情况,其中34例直视下将斑马导丝通过狭窄段尿道逆行置入膀胱,8例经膀胱造瘘口在输尿管镜引导下顺行打通并置入斑马导丝,然后选择适宜的筋膜扩张器依次递增扩张尿道,再更换F22号电切镜,切开狭窄环,必要时修整创面后留置F16～20号尿管。结果全部病例4周后拔除尿管排尿症状较治疗前明显改善,所有患者术后均坚持尿道扩张1年,40例患者排尿通畅。2例患者因尿道狭窄段较长,达2～2.5cm,局部瘢痕较硬,经扩张6个月仍排尿不畅,改行开放手术治疗成功。结论输尿管镜直视在斑马导丝引导下应用筋膜扩张器治疗对于单一短距(<2.5cm)的尿道狭窄,具有损伤小、安全、效果好、并发症少等优点。

Objective To discuss the clinical application of under direct vision ureterscope combined with fascia dilator in urethrostenosis patients who failed with utethral bougie dilation.Methods Under spinal anesthesia,the urethra explored with F8/9.8 ureterscope,implanted zebra guidewire through urethrostenosis retrograde in 34 patients,implanted zebra guidewire antegrade through suprapubic cystostomy in 8 patients,then gradual expansed with fascia dilator,implanted with F22 resectoscope to resected fibrotic narrowing ring and indwelled F16-20 catheter.Results Clinical symptoms of all patients were significantly improved 4 weeks after treatment.All patients underwent urethra dilation for 1 year,40 patients got normal voiding.2 patients had 2-2.5cm urethrostenosis with hard scar.Conclusion For sIngle and shot distance urethrostenosis,direct vision under ureterscope combined with fascia dilator has slight injury,safe,effective and less complication.