小儿输尿管镜钬激光内切开术治疗男性尿道狭窄

目的探讨小儿输尿管镜钬激光内切开术治疗男性尿道狭窄的安全性及临床疗效。 方法回顾性分析2014年8月至2017年4月我院42例行经尿道小儿输尿管镜钬激光内切开术治疗的男性尿道狭窄患者病历资料，患者年龄23～72岁，平均43岁，其中膜部尿道狭窄18例，前列腺部尿道狭窄5例，前尿道狭窄19例；狭窄段长度：0.3～2.5 cm，平均（1.4±0.3）cm，其中2例狭窄段长度2.0～2.5 cm；38例术前行自由尿流率检查，最大尿流率（Qmax）2.5～7.8 ml/s，平均（4.5±1.2）ml/s；术后留置尿管4～6周，拔除尿管后常规行尿道扩张3～4次，每次间隔1周，定期复查尿流率。 结果42例患者均顺利完成手术，手术时间30～70 min，平均（48±9）min，出血量少，无尿外渗、穿孔、感染等并发症，拔除尿管后排尿通畅。随访6～12个月，39例患者排尿通畅，最大尿流率明显改善，为12.6～22.5 ml/s，平均（16.3±3.7）ml/s，3例术后3个月尿线变细、尿流率下降行尿道扩张3～4次后排尿正常。 结论经尿道小儿输尿管镜钬激光内切开术治疗男性尿道狭窄安全、创伤小、并发症少，近期疗效满意。

Urethrotomy by holmiun laser combined pediatric ureteroscopy in the treatment of male urethral stricture

ObjectiveTo explore the safety and clinical efficacy of urethrotomy by holmiun laser combined pediatric ureteroscopy in the treatment of male urethral stricture. MethodsFrom August 2014 to April 2017, 42 male patients with urethral stricture treated by holmiun laser combined pediatric ureteroscopy in our hospital were retrospectively analyzed. Patients' age ranged from 23 to 72 years (mean 43 years). There were 18 cases of membranous part of urethral stricture, 5 cases of prostatic urethral stricture and 19 cases of anterior urethral stricture. The length of urethral stricture rangedfrom 0.3-2.5 cm (mean 1.4±0.3 cm), and the length ranged from 2.0-2.5 cm in two of them. Thirty eight cases were carried out with uroflowmetry, preoperative maximum flow rate(Qmax) was 2.5-7.8 ml/s (mean 4.5±1.2 ml/s).The urethral catheter was removed 4-6 weeks after surgery. All patients were carried out with urethra dilatation once per week (total 3-4 times), and regular reexamination of urinary flow rate. ResultsAll patients underwent surgery successfully, and the operative time was 30-70 min, with an average of (48±9) min, the blood loss was little. All patients voided smoothly after removal of catheter. No complications such as bleeding, urinary extravasation, perforation and infection occurred. After 6-12 months of follow-up, 39 patients were voiding smoothly, and maximum flow rate(Qmax) was 12.6-22.5 ml/s (mean 16.3±3.7 ml/s), After 3 months, 3 patiens were found that urinary flow rate was decreasing, which was cured by dilating the urethra 3-4 times. ConclusionUrethrotomy by holmiun laser combined pediatric ureteroscopy is safe and effective for the treatment of male urethral stricture .The recent curative effect is good.