输尿管镜辅助下双极等离子体电切治疗尿道狭窄的疗效观察  

Efficacy of bipolar plasmakinetic energy with an auxiliary ureteroscopy urethrotomy for urethral stricture

作　　者：黄黎明[1,2] 吴荣海[1,2] 庞健[1,2] 廖勇彬[1,2] 程洲平[1,2] 林绮平[1,2] 余新立[1,2] 孙明[1,2] 曹嘉正[1,2] 林伟光[1,2] 卢剑[1,2] 袁丹[1,2] 陈立新[1,2] 黄晓生[1,2] 

机构地区：[1]广东省江门市中心医院泌尿外科,529030 [2]中山大学附属江门医院泌尿外科

出　　处：《中华腔镜泌尿外科杂志（电子版）》2012年第2期31-34,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的评价输尿管镜辅助下双极等离子体电切治疗尿道狭窄的疗效和安全性。方法2004年1月至2008年12月，运用27FGYRUS双极等离子体电切镜在8-9．8FWOLF输尿管镜辅助下治疗41例男性尿道狭窄患者，年龄18～69岁，平均28岁。其中外伤性尿道狭窄27例，炎症性狭窄3例，前列腺术后狭窄8例，成人尿道下裂术后狭窄3例。所有患者经尿道造影及尿流率检查。狭窄段长度0．3—3．0cm，平均1．23cm。其中狭窄段内径〉3F者28例（A组）；狭窄段内径〈3F，且部分病例为尿道闭锁、假道者13例（B组）。术后随访12～18个月。结果全组手术成功率78％（32／41），其中A组28例中23例（前尿道11例，后尿道10例，球膜连接部2例）手术1次成功，成功率82．1％（23，28）；出现并发症5例（再狭窄3例，并发尿道穿孔、尿外渗各1例），并发症发生率14.9％（5／28）；尿道穿孔、尿外渗2例患者经留置导尿管后自行愈合，3例再狭窄患者行开放性手术。B组13例中成功9例（前尿道3例，后尿道5例，球膜部1例），成功率69．2％（9／13）；失败4例（1例因狭窄超过3．0cm术后再发狭窄，1例合并假道，2例因尿道连续性完全破坏），并发症发生率30．8％（4／13），失败原因均为术中无法标记真道。B组4例内镜失败患者同样行开放性手术治疗。结论双极等离子体电切可以有效去除尿道瘢痕组织，在输尿管镜辅助下提高了治愈成功率，适宜于可以标引真道、且狭窄段长度不超过2．0cm者，效果较好，为内镜治疗尿道狭窄的选项之一。Objective To assess the efficacy and safety of bipolar plasmakinetic energy with an auxiliary ureteroscopy urethrotomy for urethral stricture. Methods Forty one male patients （mean age 28; range 18-69 years） with urethral stricture were treated by 27 F endoscopic bipolar plasmakinetic energy （the Gyrus system） guided by 8-9.8 F ureteroscopy （the Wolf system） from Jan 2004 to Dec 2008. The eti- ologies for stricture formation were trauma （27 patients）, inflammation（3 patients）, prostatectomy（8 patients） and hypospadias repair of adult （3 patients）. The mean length of stricture was 1.23 cm （ranged from 0.3 to 3.0 cm）. According to the internal diameter of urethral stricture, the length of internal diameter more than 3 F were 28 patients （A group）, The opposite partly received obliterative urethral strictures and false passage were 13 patients （B group）. All patients were evaluated with urethrography and uroflowrnetry. They were fol- lowed up between 12 months and 18 months after endoscopic urethrotomy. Results Total success rate was 78%（32/41）, 23 patients （11 anterior urethral stricture,10 posterior urethral stricture, 2 bulbomenbraneous stricture）in A group and 9 patients （3 anterior urethral stricture,5 posterior urethral stricture, 1 bulbomen-hraneous stricture） in B group were successful firstly. Success rate of patients in A group was 82.1%（23/28） compared with 69.2%（9/13） in B group. Serious complications after endoscopic urethmtomy emerged. Incidence rate of adverse effects was 17.9%（5/28） in A group （including 3 urethral re-stenosis,1 urethral perfo- ration ,1 urinous infiltration ） and 30.8%（4/13） in B group （including 1 stricture more than 3cm in length,1 false passage,2 compete urethral rupture）respectively . In A group, 2 patients emerged from perforation and urinous infiltration healed over with catheterization.＇ And 3 patients received re-stenosis and 4 patients in B group owed to no tagging genuine urethral stricture were

关 键 词：尿道狭窄 内窥镜术 双极等离子体 

分 类 号：R699[医药卫生—泌尿科学]