球囊扩张在腹腔镜前列腺癌根治术后膀胱颈-后尿道吻合口狭窄治疗中的应用

Balloon dilatation in the treatment of vesicourethral anastomotic stricture after laparoscopic radical prostatectomy

目的:探讨球囊扩张在腹腔镜前列腺癌根治术后膀胱颈-后尿道吻合口狭窄治疗中的安全性及有效性。方法:回顾性分析2014年1月～2017年9月我院收治的腹腔镜前列腺癌根治术后膀胱颈-后尿道吻合口狭窄患者22例,平均年龄66.9岁,均无压力性尿失禁。均予尿道镜下行吻合口狭窄段球囊扩张术(F24),放置F22导尿管2～3周后拔除,定期监测其最大尿流率、平均尿流率、残余尿量、尿垫数量及尿控恢复时间。结果:术后3个月患者最大尿流率、平均尿流率均明显高于术前[(16.59±2.13)ml/s vs.(7.13±1.28)ml/s,(8.32±1.81)ml/s vs.(4.05±1.09)ml/s,P<0.05],残余尿量明显低于术前[(25.18±5.28)ml vs.(105.91±26.33)ml,P<0.05]。随访12个月,患者术后均需使用尿垫,行提肛锻炼后尿控均恢复,无尿道或膀胱损伤、尿瘘、反复血尿、反复尿路感染等并发症,无吻合口狭窄复发。结论:球囊扩张是治疗腹腔镜前列腺癌根治术后膀胱颈-后尿道吻合口狭窄的一种安全、有效的方法,值得临床推广。

Objective:To investigate the safety and efficacy of balloon dilatation in the treatment of vesicourethral anastomotic stricture after laparoscopic radical prostatectomy.Method:From January 2014 to September 2017,there were 22 patients with urinary dysfunction after laparoscopic radical prostatectomy from the same person,and these patients were finally diagnosed as vesicourethral anastomotic stricture by abdominal pelvic CT or pelvic MRI,urinary flow rate,residual urine,urodynamics,and urethoscopy etc.Their average age was 66.9 years old,and none of them was found stress urinary incontinence.All patients underwent balloon dilatation(F24),were placed F22 catheter for 2-3 weeks.The urine flow rate,residual urine,number of urine pad and urine control recovery time were recorded.Result:After three months,the maximum urinary flow rate and the average urinary flow rate increased obviously [(16.59±2.13)ml/s vs.(7.13±1.28)ml/s;(8.32±1.81)ml/s vs.(4.05±1.09)ml/s,P<0.05],and residual urine decreased obviously[(25.18±5.28)ml vs.(105.91±26.33)ml,P<0.05].After 12 months of follow-up,all patients used urine pads just after the operation,but recovered after the anal exercise.There were no complications such as urethral or bladder injury,urinary fistula,repeated hematuria,repeated urinary tract infection,and no recurrence of stricture was found.Conclusion:Balloon dilatation is a safe and effective method for the treatment of vesicourethral anastomotic stricture after laparoscopic radical prostatectomy.It is worthy of clinical promotion.