PW鞘辅助钬激光输尿管镜在男性尿道狭窄患者中的应用

Effect of PW sheath assisted holmium laser lithotripsy in the treatment of male patients with urethral stricture

目的观察PW鞘辅助钬激光输尿管镜在男性尿道狭窄患者中的应用效果。方法选择我院泌尿外科2011年5月至2014年5月收治的86例尿道狭窄男性患者,采用数表法随机分为对照组和观察组,每组43例,对照组应用钬激光输尿管镜治疗,观察组则采用PW鞘辅助钬激光输尿管镜治疗,比较两组患者治疗相关指标、治疗效果、并发症,以及复发和再手术情况。结果两组患者手术均获得成功,成功率均为100%;观察组患者的平均手术时间较对照组短,术后平均尿道扩张次数较对照组少,差异均有统计学意义(P<0.05);观察组患者最大尿流率由治疗前的(8.3±2.1)m L/s提高到(17.2±3.9)m L/s,对照组由(8.5±2.8)m L/s提高到(14.3±3.4)m L/s,组内比较差异有统计学意义(P<0.05),而观察组患者治疗后最大尿流率大于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为4.65%,明显少于对照组的25.58%,差异有统计学意义(P<0.05)。所有患者均随访至2016年5月,观察组复发率和再手术率分别为20.93%和9.30%,均明显低于对照组的44.19%和27.91%,差异均有统计学意义(P<0.05)。结论 PW鞘辅助钬激光输尿管镜可提高术中视野清晰度,使组织分辨更加容易,对提高男性尿道狭窄患者手术疗效和安全性具有显著的作用。

Objective To observe the effect of PW sheath assisted holmium laser lithotripsy in the male patients with urethral stricture. Methods A total of 86 patients with urethral stricture, who admitted to Department of Urology of our hospital from May 2011 to May 2014, were selected and randomly divided into the control group and the observation group, with 43 cases in each group. The control group was treated with holmium laser ureteroscopy, and the observation group was treated with PW sheath assisted holmium laser ureteroscopy. The treatment-related parameters,treatment effects, complications, and recurrence and re-operation were compared between the two groups. Results The treatment in the two groups of patients were successful with the success rate of 100%. The average operation time of the observation group was significantly shorter than that of the control group(P<0.05), and the average number of postoperative urethral dilation was significantly less than that of the control group, with statistically significant differences(P<0.05). After the treatment, the maximum urinary flow rate in the observation group increased from(8.3 ± 2.1) m L/s to(17.2±3.9)mL /s, and the maximum urinary flow rate in the control group increased from(8.5±2.8) mL /s to(14.3±3.4) mL /s,with statistically significant differences(P<0.05). However, the maximum urinary flow rate after treatment of the observation group was significantly larger than that of the control group(P<0.05); the complication rate of the observation group was 4.65%, which was significantly less than 25.58% in the control group(P<0.05). All patients were followed up to May 2016, and recurrence and reoperation rate in the observation group were 20.93% and 9.30%, respectively, which were significantly lower than 44.19% and 27.91% in the control group(P<0.05). Conclusion PW sheath assisted holmium laser lithotripsy can improve intraoperative visual field clarity and make the tissue easier to distinguish, which has a significant role in improving efficacy and safety of male urethral stenosis surgery.