尿道狭窄微创治疗38例治疗效果分析

Clinical Observation of Endoscopic Treatment for Urethral Stricture

目的探讨应用内镜微创治疗尿道狭窄的安全性和临床效果。方法对2008年6月-2012年7月收治的38例尿道狭窄患者应用等离子电切联合输尿管镜,行尿道内切开及尿道瘢痕电切等治疗,术后随访12-24个月,观察患者手术疗效及恢复情况,并对术后排尿情况进行分析。结果全组手术成功37例（97.37%）,改为开放手术1例（2.63%）。术后38例患者随访12-24个月,均自行排尿通畅,其中5例患者术后2个月出现尿线变细,经反复尿道扩张半年后痊愈。患者尿流率由术前的（4.1±3.4）ml/s上升至（29.2±9.4）ml/s。术中出血（18±9）ml,无尿外渗、直肠损伤或会阴部脓肿等严重并发症,1例患者因术中无法标记真道手术失败改为开放手术。5例患者术后并发暂时性尿失禁,经保守治疗后好转。结论相对传统手术,内镜微创治疗尿道狭窄具有视野清晰、出血少、瘢痕组织切除彻底、周围组织损伤小及术后再狭窄复发率低的优点,尤其适宜于可以标记真道者,是治疗男性尿道狭窄的首选术式。

Objective To investigate the safety and efficacy of endoscopic treatment for urethral stricture. Methods 38 patients with urethral stricture were applicated of the plasma electric resection combined with transurethral ureteroscopy,internal urethrotomy and urethral scar electric resection. Follow up the 38 cases after operation between 12 months and 24 months. The postoperative urination and recovery were observed in all patients. Results Total success rate was 97%（37cases）,1 case was treated with surgical repair. They were followed up between 12 months and 24 months after endoscopic urethrotomy. All had got normal voiding. 2 months after the operation,5 cases appeared weak steam of urine and recovered after the urethral dilatation for half a year. The flow rate went up to（29. 2 ± 9. 4）ml /s from（4. 1 ± 3. 4） ml /s. There were（18 ±9）ml of bleeding,no urine extravasation,rectal injury,urinary tract infections and other complications.1 case owed to no tagging genuine urethral stricture were treated with surgical repair. 5 cases were accompanied with temporary incontinence and recovered by conservative treatment. Conclusion Compared with the traditional surgery,the methods of treating urethral stricture by the plasma electric resection combined with transurethral ureteroscopy were more clear vision,less bleeding,removal of scar tissue completely with fewer damage in surrounding tissue and lower rate of postoperative recurrence of stenosis. It can be considered as the first choice of treatment of men＇ s urethral stricture and atreturethria,should be widely expand.