经尿道2μm激光治疗外伤性尿道狭窄与闭锁的应用研究  

Management of traumatic urethral stricture or atresia using Transurethral 2 μm laser

作　　者：任耀强 刘红耀[2] 刘晋峰[2] 丁业飞 

机构地区：[1]山西医科大学研究生院,太原030000 [2]山西医学科学院山西大医院泌尿外科

出　　处：《微创泌尿外科杂志》2013年第5期337-339,共3页Journal of Minimally Invasive Urology

摘　　要：目的:探讨经尿道2 μm激光尿道内切开术治疗外伤性尿道狭窄与闭锁的治疗效果.方法:50例外伤性后尿道断裂行耻骨上膀胱造瘘术和尿道会师术后再次尿道狭窄或闭锁患者,均经术前积极准备后采用2 μm激光直视下尿道内切开术治疗,最大尿流率(MFR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)作为评价手术效果的3个指标,分别于术前、术后拔除尿管、出院3个月后复查所测得.并行统计学分析.结果:50例患者经积极术前准备后均采用2 μm激光直视下尿道内切开术治疗,术中均无直肠损伤、尿瘘形成、大出血等,术后留置尿管2~4周,拔除尿管后,最大尿流率从术前的(2.7±0.8)ml/s改善为(15.7±2.1)ml/s,3个月后复查平均最大尿流率为(16.1±2.1)ml/s,IPSS评分从术前的(28.7±5.1)分改善为术后拔除尿管时的(10.2±5.4)分,术后3个月时的(8.8±5.4)分,QOL从术前的(5.7±0.5)分改善为术后拔管时的(2.1±1.7)和术后3个月时的(1.8±1.7)分,47例患者拔除尿管后尿道狭窄没有复发,3例患者复发尿道狭窄,其中1例术后拔除尿管1周出现尿失禁,50例患者拨除尿管后均按原则定期扩尿道,必要时膀胱镜下扩尿道治疗,配合排尿锻炼后全部改善.结论:经尿道2 μm激光尿道内切开术是治疗外伤性尿道狭窄或闭锁的一种适宜的好方法.Objective:To evaluate the curative efficacy of transurethral 2μm laser urethrotomy in the treatment of traumatic urethral stricture and atresia.Methods:Fifty patients underwent transurethral 2-μm laser urethrotomy who suffered from traumatic posterior urethral fracture,and occured urethral stricture or atresia after undergoing urethral realignment and suprapubic cystostomy.The maximum flow rate(MFR),the international prostatic symptom score(IPSS)and the quality of life(QOL)were measured before operation,immediately following the removal of the catheter,and 3months postoperatively.The results were recorded and analyzed.Results:The surgery was performed for all the patients with no rectum injury,urine leakage or massive blood loss.The catheter was kept for 2-4weeks. The mean MFR improved from(2.7±0.8)ml/s preoperatively to(15.7±2.1)ml/s,which kept steady to(16.1± 2.1)ml/s 3months after operation.IPSS improved from(28.7±5.1)preoperatively to(10.2±5.4)and(8.8± 5.4),respectively when catheter removal and 3months after operation.mean QOL improved from(5.7±0.5)to(2.1±1.7)and(1.8±1.7).47patients have no recurrence in the whole 3months of follow-up.Three patients got recurrence and one patients encountered with incontinence 1weeks after catheter removal,but they all improve after regular periodic urethral dilatation and physical exercise.Conclusions:Transurethral 2μm laser is a eligible method in the treatment of traumatic urethral stricture or atresia.

关 键 词：尿道狭窄或闭锁 2ΜM激光 尿道内切开术 

分 类 号：R695[医药卫生—泌尿科学]