外伤性后尿道狭窄或闭锁的腔内治疗

Endoscopic treatment of traumatic posterior urethral strictures and disruptions

目的 探讨腔内冷刀切开及瘢痕电切治疗外伤性后尿道狭窄或闭锁手术成功率。方法 回顾分析 60例外伤性后尿道狭窄或闭锁患者行尿道内切开及尿道瘢痕电切术治疗。梗阻程度 :狭窄 49例 ,长度0 .2～ 2 .5cm ,平均 1 .6cm ;闭锁 1 1例 ,0 .3cm～ 1 .5cm ,平均 0 .9cm。结果 50例 (84% )手术成功 ,其中 46例一次腔内手术成功 ,4例因狭窄复发而行二次手术成功 ;1 0例腔内手术失败而改为开放手术治疗。术后均定期行尿道扩张 ,2 2例行腔内手术患者术后 3～ 1 2个月复查尿流率 ,最大尿流率 1 4～ 35(2 0 .2± 8.9)ml/s,平均尿流率 1 0～ 2 6(1 6 .1± 5 .8)ml s。结论 腔内冷刀切开及瘢痕电切治疗骨盆骨折致后尿道狭窄或闭锁 ,方法简单、安全、疗效好、可反复治疗、创伤小 。

Objective To evaluate an endoscopic technique to treat traumatic posterior urethral strictures and disruptions in order to improve the cure rate.?Methods This study included the 60 patients who presented with traumatic strictures and dispruption of the posterior urethra underwent direct optical endoscopic urethrotomy plus trasurethral resection with a guide catheter . The length of the posterior urethral stricture was 0.2-2.5 cm with an average of 1.6 cm, and the length of the complete posterior urethral disruptions was 0.3-1.5cm with an average of 0.9cm.?Results Fifty patients(84%) have obtained good results at 3-6 months. The maximum flow rate from 14-35(20.2±8.9) ml/s and the average flow rate ranges from 10-26(16.1±5.8)ml/s in 22 paitents of them. The other patients were treated by open urethroplasty ,because of the excessive bleeding in the internal urethral incision.?Conclusion Endoscopic urethrotomy plus transurethral resection of the fibrous callus in the treatment of posterior urethral strictures and disruption is effective, simple, safe, repeatable and minimally invasive.This method is the best choice to treat the traumatic posterior urethral strictures and disruption.