TURP术后膀胱颈疤痕狭窄的三种治疗方法的比较研究

A Contrastive Study of Three Kinds of Treatment Methods for Bladder Neck Scar Stricture After TURP

目的探讨钬激光、冷刀内切和电切治疗TURP术后膀胱颈疤痕狭窄的临床效果。方法选择我院泌尿外科TURP术后出现膀胱颈疤痕狭窄的76例患者为研究对象,并随机分三组:钬激光组28例、冷刀组26例和电切组22例。比较三组患者的手术时间、术中出血量、最大尿流率、复发率和并发症发生率。结果所有患者均一次性顺利完成手术。钬激光组手术时间显著多于冷刀组与电切组(P<0.05),术中出血量显著少于冷刀组与电切组(P<0.05),最大尿流率显著高于冷刀组与电切组(P<0.05)。钬激光组、冷刀组、电切组的术后出血发生率分别为7.15%、23.08%以及9.09%,无统计学差异(P>0.05);钬激光组疤痕狭窄复发率3.58%,显著低于冷刀内切组的30.77%和电切组的27.28%(P<0.05)。结论内镜下钬激光切除术治疗TURP术后膀胱颈疤痕狭窄与冷刀切开术和汽化电切术比较均具有出血量少、效果明显、复发率低等优点,是一种治疗TURP术后膀胱颈疤痕狭窄的疗效更好,可靠性、安全性更高的的理想方法。

Objective To explore the clinical effects of holmium laser, cold knife cut inside and electricity cut for the treatment of patients with bladder neck scar stricture after TURP. Methods Seventy-six cases of patients with bladder neck scar stricture after TURP were selected and randomly divided into three groups, with 28 cases of holmium laser group, 26 cases of cold knife group and 22 cases of electricity cut group. The operation time, intraoperative blood loss, maximum urinary flow rate, recurrence rate and complications were compared among three groups. Results The operations of all the three groups finished by one-time. The operation time of holmium laser group was significantly longer than that of cold knife group and electricity cut group（P〈0.05）, the intraoperative blood loss was significantly less than that of cold knife group and electricity cut group（P〈0.05）, and the maximum urinary flow rate was significantly higher than that of cold knife group and electricity cut group（P〈0.05）. The incidences of postoperative bleeding of holmium laser group, cold knife group and electricity cut group were 7.15%, 23.08% and 9.09% respectively, with no statistical differnces（P〈0.05）. The recurrence rate of scar stricture of holmium laser group was 3.58%, significantly lower than 30.77% of cold knife group and 27.28% of electricity cut group（P〈0.05）.Conclusions Compared with cold knife cut inside surgery and transurethral resection, holmium laser resection under endoscopy has the advantages of less bleeding, more significant effect and lower recurrence rate for the treatment of patients with bladder neck scar stricture after TURP, which is an ideal method with high reliability and security.