肾镜联合输尿管镜治疗尿道狭窄32例报告  

Nephroscope combined with ureteroscope for urethral stricture(Report of 32 cases)

作　　者：吴文弼 侯瑞鹏[2] 张宝勋 

机构地区：[1]平凉市第二人民医院泌尿外科,甘肃平凉744000 [2]天津市人民医院泌尿外科

出　　处：《临床泌尿外科杂志》2015年第5期442-443,447,共3页Journal of Clinical Urology

摘　　要：目的：探讨肾镜联合输尿管镜治疗尿道狭窄的临床价值及疗效。方法：回顾性分析32例用肾镜联合输尿管镜治疗尿道狭窄患者的临床资料：所有患者术前均进行尿道造影确定狭窄部位及长度。利用输尿管镜（F8 /9.8）直视下找见狭窄部位并留置斑马导丝，将斑马导丝穿过肾镜闭孔器内，在导丝引导下用肾镜扩张尿道。当肾镜无法通过时，用肾筋膜扩张器（F12～18）逐级扩张后再用肾镜沿斑马导丝进行扩张，留置F16～18双腔气囊尿管2周。拔管后每周扩张尿道1次，扩张至F20～22,持续8～10次后根据尿道通畅程度决定是否继续扩张。结果：32例患者均一次性完成手术，手术时间18～40min，无大出血、尿道热、直肠损伤、假道等并发症。拔除尿管后排尿通畅，尿线粗，最大尿流率为19～25ml／s。随访5～12个月，无尿失禁、勃起功能障碍，间断扩张2～3个月，其中１例因未坚持尿道扩张，2个月后病情复发，再次行肾镜扩张后排尿通畅，其余患者排尿正常。结论：肾镜联合输尿管镜治疗尿道狭窄简单、安全、有效。Objective： To investigate the clinical value and efficacy of nephroscope combined with ureteroscopefor urethral stricture. Method： We retrospectively analyzed the clinical data of 32 patients of urethral stricture treated with nephroscope combined with ureteroscope. All patients underwent urethrography preoperatively to de- termine the extent and length of urethral stricture. The position of stricture was found by ureteroscopy （F8/9.8） under direct vision and the zebra guidewire was put. Then the zebra guidewire was threaded through nephroscope obturator and guided the nephroscope to expand the narrow segment. When the nephroseope couldn＇t get through, it was expanded step by step using renal fascia dilator （F12 l8 ）. Then the zebra guidewire leaded the nephroscope to expand again. The F16～18 Foley catheter was indwelled for two weeks. The urethral dilation was taken once a week after extubation till expanding to F20-22. Whether to continue the expansion after 8-10 times depended on the smooth degree of the urethra. Result： All 32 patients were completed the operation in one time for 18-40 min. There were no bleeding, urinary fever, rectal injury, false passage or other complications. The urination was easy and smooth after catheter was removed and the maximum flow rate was 19-25 ml/s. There was no complication such as incontinence, erectile dysfunction over the follow-up period of 5-12 months. The intermittent expansion was taken for 2-3 months. There was one case who failed to dilate urethral and relapsed after two months. He was dilated urethra again by the nephroscope and the urination was unobstructed. Other patients urination were easy and smooth. Conclusion： The treatment of urethral stricture by nephroscope combined with ureteroseope is sim- ple, safe and effective.

关 键 词：尿道狭窄 肾镜 输尿管镜 

分 类 号：R695[医药卫生—泌尿科学]