输尿管镜下应用球囊扩张器联合1470 nm激光在男性尿道狭窄治疗中的临床应用

Clinical application of ureteroscopy with balloon dilator and 1470 nm laser in the treatment of male urethral stricture

目的比较输尿管镜下应用球囊扩张器联合1470 nm激光与冷刀内切开治疗男性尿道狭窄的疗效及安全性。方法回顾性分析黑龙江省医院2019年6月至2021年6月收治的男性尿道狭窄患者52例的临床资料,依据手术方法不同分为两组,联合组28例采用输尿管镜下应用球囊扩张器联合1470 nm激光治疗,冷刀组24例采用尿道冷刀内切开治疗。比较两组患者手术时间、术后住院时间、复发率、再手术率、术后并发症、残余尿量(RUV)、术后拔除尿管1个月最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)。结果两组手术时间、术后住院天数、术后并发症发生率差异无统计学意义(P>0.05);联合组术后复发率、再手术率均明显低于冷刀组,差异有统计学意义(P<0.05);两组术后RUV均低于术前,但两组手术前后RUV比较,差异无统计学意义(P>0.05);两组术后Qmax均高于术前(P<0.05),且术后联合组Qmax明显高于术后冷刀组,差异有统计学意义(P<0.05);两组术后IPSS评分、QOL评分均较术前降低(P<0.05),两组术前IPSS评分、QOL评分差异无统计学意义(P>0.05),两组术后IPSS评分、QOL评分差异无统计学意义(P>0.05)。结论输尿管镜下应用球囊扩张器联合1470 nm激光治疗男性尿道狭窄,与尿道冷刀内切开术比较具有降低手术复发率、减少手术次数、明显改善排尿功能等优势,是治疗男性尿道狭窄疗效更好的手术方式。

Objective To compare the efficacy and s afety of balloon dilator com bined with 1470 nm laser under ureteroscopy and internal urethrotomy with cold knife in the treatment of male urethral stricture.Methods The clinical data of 52 male patients with urethral stricture admitted to Heilongjiang Provincial Hospital from June 2019 to June 2021 were retrospectively analyzed and 52 patients were divided into two groups according to different surgical methods.The combination group(n=28)was treated with the balloon dilator combined with 1470 nm laser under ureteroscopy,and the cold knife group(n=24)were treated with internal urethrotomy with cold knife.The operation time,postoperative hospital stay,recurrence rate,reoperation rate,postoperative complications and residual urine volume(RUV),maximum urinary flow rate(Qmax)after catheter removal for 1 month after operation,international prostate symptom score(IPSS),quality of life(QOL)assessment were compared between the two groups.Results There were no significant differences in operation time,postoperative hospital stay,and postoperative complication rate between the two groups(P>0.05);the postoperative recurrence rate and reoperation rate of the combination group were significantly lower than those of the cold knife group,with statistically significant differences(P<0.05);the postoperative RUV of the two groups was lower than that before operation,with no statistically significant difference(P>0.05);the postoperative Qmax of the two groups was higher than that before operation(P<0.05),and the postoperative Qmax in the combination group was significantly higher than that in the cold knife group,with statistically significant difference(P<0.05);the postoperative scores of IPSS and QOL of the two groups were lower than those before operation(P<0.05).There were no significant differences in IPSS and QOL scores between the two groups before operation(P>0.05),and there were no significant differences in IPSS and QOL scores between the two groups after operation(P>0.05).Conclusion The use of balloon dilator and 1470 nm laser under ureteroscopy in the treatment of male urethral stricture has the advantages of reducing the recurrence rate and the number of operations,and significantly improving urination function,compared with internal urethrotomy with cold knife.Therefore,it is a better surgical method for treating male urethral stricture.