电子输尿管镜联合2μm激光治疗尿道狭窄的疗效分析

Efficacy of digital ureteroscope combine 2 micron continuous-wave laser vaporesection for the treatment of urethral stricture

目的探讨电子输尿管镜联合2μm激光治疗尿道狭窄的疗效。方法山西大医院2012年1月至2014年8月采用电子输尿管镜联合2μm激光治疗尿道狭窄30例（长度1.0~2.5 cm,平均1.3±0.4 cm）,术后6周拔除尿管,定期尿道扩张4~6次。结果本组30例,1次手术成功率100%,手术时间20~60 min,平均（34±9）min,拔除尿管后最大尿流率（Qmax）为15.9~25.5 ml/s,平均（21.2±3.2）ml/s。全部病例均未出现严重出血、尿道穿孔、假道形成、尿瘘、直肠损伤、尿失禁等并发症。随访4~12个月,29例术后无复发和再狭窄,最大尿流率（Qmax）均〉15 ml/s,膀胱残余尿量〈50 ml,1例术后3个月尿线变细,行膀胱镜下尿道扩张后治愈。结论电子输尿管镜联合2μm激光治疗尿道狭窄,手术视野清晰、创伤小、并发症少、效果明显、安全可靠,近期疗效满意。

Objective To explore the efficacy of digital ureteroscope combine 2 micron continuouswave laser vaporesection for the treatment of urethral stricture. Methods 30 cases with urethral stricture（1.0~2.5 cm length, average 1.3 ±0.4 cm） accepted the treatment of digital ureteroscope combine 2 micron continuous-wave laser from January 2012 to August 2014. After operation urethral catheters were remained for 6 weeks and received urethral dilation regularly for 4-6 times. Results 30 procedures were all successful. The operation time was 20-60min（average 34±9 min） and the average peak urinary flow rate was15.9-25.5 ml/s, average 21.2±3.2 ml/s. There was no complication such as urethral perforation, false passage,urinary fistula, rectal injury and postoperative uroclepsia occurred. 30 cases were followed up for4-12 months. After three months one-case was cured by dilating the urethra under the cystoscope, other 29 cases had no recurrence（Qmax15ml/s）and bladder residual urine volume was less than 50 ml. Conclusion With clear field of vision, less trauma, fewer complications, obvious effects, digital ureteroscope combine2 micron continuous-wave laser vaporesection is safe and effective for the treatment of urethral stricture. The recent curative effect is satisfying.