经输尿管镜钬激光顺行内切开治疗男性尿道狭窄  

Holimum:YAG laser antegrade internal urethrotomy through ureteroscope on male urethral stricture

作　　者：杨航[1] 王庆堂[1] 陈卫国[1] 王亮[1] 曹文峰[1] 李沙丹[1] 王起武[1] 

机构地区：[1]成都军区总医院泌尿外科,四川成都610083

出　　处：《中国内镜杂志》2010年第11期1180-1183,共4页China Journal of Endoscopy

摘　　要：目的探讨经输尿管镜钬激光顺行切开治疗男性尿道狭窄的临床价值及方法。方法该组44例,尿道狭窄原因包括外伤性23例,前列腺电切术后10例,留置尿管5例,炎症性4例,尿道成形术后2例。狭窄段长度<1.0cm的21例,1.0～2.0cm的17例,>2.0cm的6例。合并假道9例,膀胱结石3例,肾功能不全8例。术前平均最大尿流率(4.0±2.1)mL/s。采用表面麻醉(狭窄长度<2.0cm)或硬脊膜外阻滞麻醉(>2.0cm),输尿镜直视通过狭窄段,钬激光顺行性放射状切开并清除瘢痕。结果均成功切除瘢痕,无直肠损伤、尿失禁、尿瘘及假道等并发症,术后平均最大尿流率为(16.5±2.7)mL/s。28例行尿道扩张2～8次,36例随访6～24个月,其中5例复发,行2次钬激光内切开后治愈。膀胱结石3例均一期清石,肾功能不全6例恢复正常。结论经输尿管镜钬激光内切开操作简单,切除瘢痕准确,是尿道狭窄腔内治疗的有效方法。【Objective】To investigate the methods and therapeutic value of Holimum：YAG laser applied in antegrade internal urethrotomy on male urethral stricture through ureteroscope.【Methods】A total of 44 patients was enrolled in this study.The etiology of the urethral stricture include trauma in 23,inflamation in 4,post TURP in 10,post catheteration in 5,and post urethroplasty in 2 cases.The length of the stricture was found less than 1.0 cm in 21,1.0～2.0 cm in 17,and 2.0 cm in 6 cases.Complications were diagnosised in 9 cases with false passage,3 with bldder stone,and 8 with renal failure.The mean preoperation Qmax was （4.0±2.1） mL/s.Superficial anesthesia and epidural anesthesia perofrmed for stricture length less than 2.0 cm or over 2.0 cm respectively.The ureteroscope passed through the stricture into the bladder under direct vision,then pulled distally while antegrade radial incision and elimination of the scar was made using the holmium：YAG laser.【Results】Antegarade endoscopic Ho：YAG laser urethrotomy succesfully performed in all patients with no complications as rectal injury,urinary incontinence,urinary fistula,and false passage occured.The mean postoperation Qmax was （16.5±2.7） mL/s.Twenty-eight patients treated with intermittent urethral dilatation 2～8 times postoperatively.Follow-up continued in 6～24 months for 36 patients.Five patients developed recurrent strictures that were treated by another laser urethrotomy and achived stablized status.The renal function recovered in 6 cases and the bladder stone removed completely in 3 cases.【Conclusions】 Holimum：YAG laser antegrade internal urethrotomy through ureteroscope is simple in operation,reliable and accurate in scar clearence.It is deserved to be the primary procedure for selected urethral stricture patients.

关 键 词：尿道狭窄 尿道内切开 输尿管镜 钬激光 

分 类 号：R699.6[医药卫生—泌尿科学] R695[医药卫生—外科学]