耻骨上经膀胱输尿管镜顺行引导治疗尿道后尿道瓣膜及闭锁(附6例报告)

Suprapubic Ureteroscopy Antegrade Guide Treatment of Posterior Urethral Valves and Atresia(a Report of 6 Cases)

目的:通过耻骨上经膀胱输尿管镜顺行引导治疗后尿道瓣膜及闭锁,为临床工作开辟一条新途径。临床资料:本组6例病人均为男性,年龄26岁-72岁,平均年龄40.5岁。除一位72岁老人前列腺增生术后后尿道瓣膜一直寻求治疗外,其它五位病人均已留置膀胱造瘘管多年,基本已放弃治疗。方法:入选的患者均经膀胱输尿管镜顺行引导建立标记,以钬激光建立通道,然后以等离子体刀进行瘢痕汽化进一步扩大尿道腔,直至电切镜鞘通过狭窄段,最后留置F18-22#三腔尿管三周,拔除尿管后定期扩张。结果:6例病人经治疗后均予以定期尿道扩张,随访1-9年,均恢复正常排尿。结论:我们认为耻骨上经膀胱输尿管镜顺行引导治疗后尿道瓣膜及闭锁的方法,可以大大提高手术成功率,标记或通道建立后应当尽量采取等离子汽化治疗,可提高病人的远期疗效。因此我们认为耻骨上经膀胱输尿管镜顺行引导治疗后尿道瓣膜及闭锁,解决了后尿道瓣膜及尿道闭锁治疗中的难题,为临床工作开辟了一条新途径,是值得推广的方法。

Abstraet：Objective： To open up a new way for clinical work through suprapubic ureteroscopy antegrade guide treatment of posterior urethral valves and atresia. Clinical data： The group of 6 patients were male,age 26 years old -72 years old,the av- erage age was 40. 5 years. Except for a 72 years old man with posterior urethral valves had been seeking treatment after prostateetomy,tbe other 5 patients had been indwelling bladder fistula for years and basically abandoned clinical treatment. Methods： All the seleeted patients with posterior urethral valves and atresia were established markers by suprapubie ureteroscopy ante- grade guide, ues holmium laser to establish channels, then use plasma knife sear vaporization to further expand the urethral lu- men, until the reseetoseope sheath through the narrow seetion. F18- 22# three cavity catheter was indwelled for three weeks, with regular urethral dilation after removal of catheter. Results：All 6 patients after treatment were performed regular urethral dilatation, followed up for 1 -9 years, all patients were restored to normal urination. Conclusion： We con- elude that the suprapubie ureteroseopy antegrade guide treatment of posterior urethral valves and atresia can greatly improve the success rate of operation. Plasma vaporization treatment shall be taken after establishment of markers or channels. This may im- prove the patient~ long - term efficacy. So we believe suprapubie ureteroscopy antegrade guide treatment of posterior urethral valves and atresia solves the problems in the treatment of poste- rior urethral valves and atresia, which opens up a new way for clinical work and is worth popularizing. Key words： suprapubic; ureteroscopy antegrade guide ; pos- terior urethral valves m^d atresia