钬激光联合电切治疗后尿道狭窄与开放手术的疗效比较

目的:评价钬激光联合电切与传统开放手术治疗后尿道狭窄及闭锁的疗效及安全性。方法:收治后尿道狭窄及闭锁患者40例,非选择性对其中18例采用钬激光联合电切尿道狭窄内切开术,22例患者行传统开放手术切除瘢痕加尿道吻合术。40例随访12～20个月,平均15个月,比较两组术中及术后的相关临床指标,包括手术时间、术中出血量、留置尿管时间、术后尿道扩张次数、住院时间、治愈率及尿失禁、尿外渗及继发出血等并发症发生情况。结果:钬激光联合治疗组治愈率83.3%,开放组治愈率86.3%,2组术后最大尿流率均明显改善,组间差异无统计学意义(P>0.05);钬激光联合治疗组平均手术时间,术中出血量,住院时间,留置尿管时间,并发症发生率,尿失禁及阴茎勃起功能障碍等均少于开放手术组(P<0.05)。术后尿道扩张次数组间无显著差异(P>0.05)。结论:钬激光联合电切是治疗单纯性后尿道狭窄的首选方法。开放手术在复杂性尿道狭窄的治疗上有明显优势,而且是解决尿道狭窄的最终方法。

Comparison of combined holmium laser incision with electro-incision and the open surgery in the treatment of the latter urethral stricture

Objective:To compare the clinical efficacy and safety of combined holmium laser incision with electro-incision and the open surgery for the latter urethral stricture and close.Methods:A total of 40 patients who were diagnosed with urethral stricture and atresia,18 cases of urethral stricture were randomly assigned taken combined therapy with holmium laser incision and electro-incision(combined therapy group),while another 22 cases of urethral stricture patients were taken traditional open surgery(traditional therapy group).All patients were followed up for 12 to 20 month average 15 months.The significant markers and therapeutic results were recorded and analyzed,which includes operating time,the blood loss,the time of Foley catheters indwelled,the number of time for urethra dilation,the cure rate and secondary complications such as bleeding,urine leakage.The therapeutic effects were compared in the two groups.Results:the cure rate of combined therapy group is 83.3%.the cure rate of the open operation group is 86.3%.The maximal urinary flow rate(Qmax) improved after operation.The therapeutic effect showed similar between two groups(P>0.05).But the mean operation time,the blood loss,the times in hospital and the time of Foley catheters indwelled is less in combined therapy group(P<0.05),The number of time for urethra dilation were found no significant differences between the two groups(P<0.05).The complication is less in combined therapy group.Conclusions:combined holmium laser incision and electro-incision should be considered as the first choice for simplex urethrostenosis.Open surgical operation is the final treatment and is better for complex urethral stricture.