内腔镜手术治疗尿道狭窄18例临床分析

目的探讨内腔镜下钬激光结合等离子电切治疗尿道狭窄与闭锁的疗效与安全性。方法采用钬激光或等离子尿道内切开及电切治疗尿道狭窄与闭锁患者18例。致伤原因:外伤所致12例,导尿后引起炎症狭窄2例,前列腺术后致尿道内口狭窄4例。狭窄段长度0.8～2.0 cm,平均1.4 cm,其中后尿道闭锁2例(闭锁段长度0.8～1.0 cm)。结果 15例一次手术成功,2例因狭窄复发经2次腔内手术成功,1例行3次腔内手术后再狭窄而改为开放手术治愈,无直肠损伤、尿失禁、尿瘘及假道等并发症。最大尿流率为12～24 ml/s(平均16 ml/s)。术后随访16例,均定期行尿道扩张,随访4～19个月,排尿通畅。结论内腔镜下钬激光结合等离子电切治疗尿道狭窄与闭锁具有术中操作简单,安全有效,并发症少的优点,是治疗尿道狭窄的有效方法。

Transurethral Holmium Laser and Bipolar Plasma Kinetic Technology for Posterior Urethral Stricture(Report of 18 Cases)

Objective To study the effect and safety of transurethral holmium laser and bipolar plasma kinetic technology in treatment of urethral stricture.Methods 18 cases of urethral stricture were treated with holmium laser or bipolar plasma kinetic technology through endoscopy.The etiology of the urethral stricture include trauma in 12 cases,inflammation after catheterization in 2 cases,post TURP in 4 cases.The length of the stricture was 0.8-2.0 cm(mean 1.4 cm).2 cases suffered posterior urethral atreturethria(the length of the atreturethria was 0.8-1.0 cm).Results 15 cases were cured by a single operation,2 cases needed a second endoscopic incision for recurrent stricture after the first surgery,1 case was cured by open operation after undergoing three times endoscopic incision.No complication such as rectal injury,urinary incontinence,urinary fistula and false passage was found.The maximum urine flow rate was 12-24 ml/s(mean 16 ml/s).All patients were carried out with urethral dilatation after operation.16 cases were followed up for 4-19 months;a satisfactory voiding has been achieved.Conclusion The endoscopic treatment of urethral stricture and atreturethria with Holmium laser combined with transurethral electronic incision has the advantages of simple operation,safety,effectiveness and less complication.It is an effective method for urethral stricture.