输尿管镜联合尿道切开镜治疗9例尿道狭窄

目的探讨输尿管镜联合尿道切开镜治疗尿道狭窄的疗效。方法骶管麻醉下用F8/9.8输尿管镜检查尿道狭窄情况,直视下将导丝通过狭窄段尿道置入膀胱。如尿道狭窄段无小孔通道,可从膀胱造瘘管内注入美蓝液,再用力按压膀胱,同时观察闭锁远端有无蓝色液体渗出。改尿道切开镜循导丝的后尿道于12点处切割狭窄环,前尿道于6点方向切开,边切割边推进尿道镜,直至24F尿道内切开镜进入膀胱。术后常规留置F18～F22三腔气囊导尿管4～6周,运用抗生素治疗,拔管后定期行尿道扩张1～3月。结果本组患者手术均一次切开成功。本组手术时间35～83 min,平均46 min。术后住院5～8 d。留置导尿管拔出后l周内排尿通畅,19～21F尿道扩张器通过顺利。无尿失禁、尿外渗、继发性出血,尿道热等发生。结论输尿管镜直视下留置安全导丝,再行尿道切开镜治疗尿道狭窄可有效减少尿道穿孔或假道的发生,是一种并发症少、创伤小、住院时间短、恢复比较快的手术方法。

Treatment of urethral strictures with ureteroscopy combined with urethoroscope

Objective To explore the effectiveness of treatment on urethral strictures by ureteroscopy combined with urethoroscope.Methods Using sacral anesthesia and F8/9.8 ureteroscopy,we checked the situation of urethral strictures.Under direct ureteroscopy visual condition,we put guidewire into bladder through narrow segment of urethra.If there was not little hole through narrow segment of urethra,we influxed methylenum through tube of vesicostomy and then put strength on the bladder and watched whether there was blue fluid pouring from the atresia of urethral at the same time.Using urethoroscope along guidewire,we incised urethral stricture at 12 o’clock at posterior urethra and at 6 o’clock at anterior urethra.We incised stricture,while carrying forward urethrotomy until putting 24F urethrotomy into bladder.After urethrotomy 4 to 6 weeks,an indwelling F18~22 catheter was conventionally left in place.Urethral dilatation was performed within 1 to 3 months of removal of the catheter on time.Results The group of patients were all operated successfully.The mean operation time was 46 min(35~83 min).The postoperative hospital stay was 5~8 days.One week after indwelling catheter was removed,the patients voided unobstructed.F19~22 divulsor pass urethra successfully.None had the complications of urinary incontinence,urinary extravasation,secondary hemorrhage or urethra hot.Conculsion Uuder direct urethroscopic visual,we first detained safe guidewire and then treated urethral strictures by urethoscope.It decreased effectively urethral perforation and false passage and was a safe and effective operation,with less complication,small trauma,short time of hospitalization and rapid recovery.