改良直视下尿道扩张术治疗尿道狭窄20例

Modified urethral dilatation under direct vision of endoscope to treat the urethral stricture in 20 cases

目的：探索膀胱镜下应用输尿管导管治疗尿道狭窄的方法,评价该方法的疗效。方法：回顾分析2010年9月-2012年9月我院收治的20例尿道狭窄患者的临床资料。其中11例有下腹部开放手术病史,均因急性尿潴留就诊且留置导尿管及尿道扩张失败。所有患者在19.5 F膀胱镜直视下,应用输尿管导管扩张后利用镜体进一步扩张,术后留置16 F或18 F导尿管1～2周,后常规定期尿道扩张。结果：20例均手术成功留置导尿管,术后1周拔除导尿管后均能顺利进行常规的盲视下尿道扩张术并排尿顺畅,术后随访3个月至2年,5例排尿顺畅不再治疗,其余患者均能顺利进行定期常规尿道扩张。结论：在尿道狭窄治疗中,膀胱镜下输尿管导管扩张术具有较满意的疗效,相对常规盲视尿道扩张而言,能够避免尿道假道形成,尤其对于有下腹部开放手术病史的急性尿潴留患者,可避免膀胱穿刺造瘘所致的肠穿孔风险。

Objective： To explore the method of the urethral under cystoscopy to treat the urethrostenosis and to evaluate the curative effect of this method. Methods： The therapeutic data of the urethrostenosis in 20 cases admitted to our hospital from September 2010 to September 2012 were retrospectively analyzed. Of them, 11 cases had the history of lower abdominal open operation and all of them were admitted to hospital because of acute urine retention and failure to indwell catheter and urethral dilatation. All patients were further dilated with cystoscopy under direct vision of 19.5 F cystoscopy after the ureteral catheter dilatation. 16 F and 18 F catheters were indwelled for 1-2 weeks after operation, then the conventional regular dilatation was performed. Results： Operations were successfully performed and catheter was indwelled in 20 cases. Of them, the conventional urethral dilatation could be smoothly performed under the blindness and urine could swimmingly urinate after catheter was removed postoperatively 1 week. Postoperative follow-up for 3 months-2 years. Five cases of swimmingly urination needn＇t treat again, the rest of patients could smoothly undergo regular urethral dilatation. Conclusion： The endoscope dilatation technique for treatment of urethral stricture has better effect, and can avoid urethral false passage, especially for patients with acute urinary retention with lower abdominal open operation history and can avoid risks of bladder puncture fistulation and the intestinal perforation.