线型电刀在尿路狭窄梗阻电切术中的应用

Application of Linear Electric Knife in the Urethroplasty of Urinary Obstruction or Stenosis

目的探讨线型电刀在泌尿外科梗阻或狭窄性疾病治疗中的临床应用价值。方法选取我院2013年6月~2015年6月收治的男性尿道梗阻或狭窄性疾病患者80例,其中尿道狭窄20例,狭窄长度为0.5~2.8 cm;输尿管狭窄34例,狭窄长度为0.5~3 cm;UPJO 2例;输尿管结石合并息肉24例。按治疗方法不同分为线型电刀组(观察组)和钬激光组,各40例,在输尿管镜下分别行线型电刀电切术和钬激光切除术。比较两组患者疗效和并发症情况。结果 20例尿道狭窄患者均一次手术成功;34例输尿管狭窄患者术后3个月复查示患侧输尿管通畅无梗阻;2例UPJO患者经钬激光手术后狭窄解除;24例输尿管结石合并息肉患者术后23例狭窄解除,1例(钬激光组)狭窄未解除,经开腹手术后狭窄解除。组间尿管留置时间、住院时间及术后最大尿流率比较,差异均无统计学意义(P>0.05),但术后线型电刀组手术时间短,尿道扩张次数少,而术中出血量高于钬激光组,差异有统计学意义(P<0.05)。线型电刀组膀胱痉挛发生率、复发率及再手术率均低于钬激光组(7.5%VS 17.5%,10.0%VS 20.0%,2.5%VS 10.0%),差异均有统计学意义(P<0.05)。结论腔镜下行线型电刀经尿路成形术治疗泌尿外科梗阻或狭窄性疾病,具有疗效确切,创伤小,并发症少,复发率低,适应证广等优势,在治疗更为复杂的泌尿外科梗阻或狭窄性疾病中可能优于钬激光切除术,临床应用前景良好可期。

Objective To explore the clinical value of linear electric knife in urethroplasty of urinary obstruction or stenosis.Methods The clinical data of 80 male cases suffered urinary obstruction or stenosis were retrospectively analyzed,including 20 urethral stricture cases with length of stenosis ranged from 0.5 to 2.8 cm,34 ureteral stenosis cases with length of stenosis ranged from 0.5 to 3 cm,2 cascs of UPJO and 24 cases with ureteral calculi combined polyps.According to surgical method under ureteroscope,they were divided into two groups with 40 cases for each：The observation group was performed electrocision with linear electric knife,and the control group was performed urethrotomy with holmium laser.Results A total of 79 cases were completed the surgery successfully,including 20 of urethral stricture,34 of ureteral stricture,2 of UPJO （by holmium laser surgery） and 23 of ureteral calculi combined with polyps.But one case with ureteral calculi with polyps failed by holmium laser and gained stenosis relief by reoperation of open surgery.There was no statistical difference in urinary catheter indwelling time,hospital stays and postoperative maximum flow rate between two groups （P ＞ 0.05）.Compare to the control group,the operative time was shorter,urethra expansion times was less,but intra-operative blood loss volume was higher in the observation group （P ＜ 0.05）.The post-operative complications rate of cystospasm,recurrence rate and reoperation rate were lower in the observation group than those in the control group （7.5％ VS 17.5％,10.0％ VS 20.0％,2.5％ VS 10.0％）,and there were statistical differences （P ＜ 0.05）.Conclusions The endoscopic urethroplasty with linear electric knife can achieve an ideal effect with advantages as mini-trauma,less complication,lower recurrence rate and extensive indication for urinary obstruction or stenosis,especially suitable for complex cases.So its clinical application will be prospected.