绿激光尿道切开术治疗短段后尿道狭窄的长期效果分析

Long-term Outcome in Treating Short Segment Posterior Urethral Stricture Using Green Light Laser Urethrotomy

目的男性后尿道狭窄(posterior urethral stricture,PUS)在泌尿外科领域内一直是亟待解决的难题。笔者利用绿激光尿道切开术治疗短段PUS(<2cm)取得了较好的治疗效果,在本研究中笔者将分享笔者的数据和经验。方法 2011年5月至2014年5月间,本单位新收治的短段PUS患者被随机分为两组。一组患者接受绿激光(80W)尿道切开术治疗(激光组),一组患者接受狭窄段切除然后行尿道端端吻合术(开放组)。比较并统计两组的围术期和术后各项有关参数的差别。结果与开放组比较,激光组的手术时间明显缩短(P<0.001)、术后留置尿管时间明显缩短(P<0.001)、住院时间明显缩短(P=0.022)。激光组患者术后接受重复尿道扩张的次数要多于开放组(P=0.036)。激光组患者术后并发症的发生率,包括皮肤尿道瘘(0)、尿路感染(1.69%)、血肿(0)、一过性勃起功能障碍(5.08%)、附睾炎(1.69%)和阴茎水肿(6.78%)均明显低于开放组(分别为7.84%,P<0.001;9.80%,P=0.017;5.88%,P<0.001;13.73%,P<0.001;9.80%,P<0.001;11.76%,P=0.031)。两组的术后评估参数,包括最大尿流率(P<0.001)、国际前列腺症状评分(P<0.001)和生活质量分数(P<0.001),均较术前明显改善。而对于上述术后随访的参数,两组在随访的每个观察点之间并无明显统计学差别(P>0.05)。结论绿激光尿道切开术安全有效,可用来治疗短段PUS。

Objective Male posterior urethral stricture（ PUS） has always been a challenge for urologists. In the present study,our experience in management of short segment PUS（ 2 cm） with Green Light laser urethrotomy was reported. Methods Between May 2011 and May 2014,male patients with newly diagnosed short segment PUS in our center were randomly divided into two groups. Patients in laser group received Green Light laser（ 80 W） urethrotomy,and patients in open group received excision and primary anastomosis urethroplasty. Then the perioperative and postoperative parameters were compared. Results Results showed that laser group had significant shorter operation time [（ 24. 2 ± 13. 4） minutes vs.（ 69. 2 ± 19. 4） minutes,P〈0. 001],catheterization time [（ 4. 7 ± 1. 3） days vs.（ 30. 1 ± 7. 2） days,P〈0. 001] and hospital stay duration time[（ 4. 3 ± 2. 5） days vs.（ 9. 4 ± 3. 7） days,P = 0. 022]compared with the open group,respectively. The patients in laser group underwent more times [（ 3. 7 ± 1. 5） times,P = 0. 036]of postoperative urethral dilation than those in open group [（ 2. 1 ± 0. 5） times]. Complications rates in laser group,such as urethro-cutaneous fistula（ 0%）,urinary tract infection（ 1. 69%）,hematoma（ 0%）,transient erectile dysfunction（ 5. 08%）,epididymitis（ 1. 69%） and penile edema（ 6. 78%）,were lower than those in open group（ 7. 84%,P〈0. 001; 9. 80%,P = 0. 017; 5. 88%,P〈0. 001; 13. 73%,P〈0. 001; 9. 80%,P〈0. 001; 11. 76%,P = 0. 031; respectively）. Postoperative assessments in two groups, including maximal urinary flow rate（ P〈0. 001）,International Prostate Symptom Score（ P〈0. 001） and quality of life index（ P〈0. 001）,were significantly better compared with baseline values,respectively. At each time point of follow-up,the parameters in the laser group were comparable（ P〈0. 05） with the open group. Conclusions Green Light laser urethrotomy could be a safe and effective option in treating the short segment PUS.