应用200μm钬激光光纤治疗球、膜部尿道狭窄临床分析及新思考  

Clinical Analysis and New Thinking of 200μm Holmium Laser Fiber in the Treatment of Bulbar and Membranous Urethral Stricture

作　　者：高江涛[1] 程梦雅[1] 毛长青[1] 谢遵江[2] Gao Jiangtao;Cheng Mengya;Mao Changqing(Department of Urology,First People’s Hospital of Zhengzhou,Zhengzhou,Henan,450004,China)

机构地区：[1]郑州市第一人民医院泌尿外科,河南郑州450004 [2]哈尔滨医科大学解剖学教研室,黑龙江哈尔滨150081

出　　处：《黑龙江医学》2024年第5期521-524,共4页Heilongjiang Medical Journal

基　　金：河南省医学科技攻关计划项目(LHGJ20191003)。

摘　　要：目的:分析和思考内镜下应用(200μm)钬激光光纤治疗球、膜部尿道狭窄的疗效及治疗经验。方法:选取2018年1月—2020年6月样本医院收治的86例内镜下应用冷刀及200μm钬激光光纤治疗男性球、膜部尿道狭窄患者的临床资料进行分析。所有患者尿道造影均提示狭窄段<1 cm,彩超检查提示瘢痕厚度<0.5 cm和(或)合并部分假道。按手术方式分为两组,对照组(冷刀组,41例):应用冷刀纵形辐射状切开狭窄段至正常海绵体深度;观察组(激光组,45例):采用200μm钬激光光纤,“同轴法”纵向切开狭窄段并切除尿道瘢痕,深度同对照组。术后均留置16 F硅胶尿管,2周后拔除,观察其自行排尿情况。结果:观察组患者手术时间长于对照组,术中、术后出血量少于对照组,差异有统计学意义(t=8.494、15.112、14.351、13.300,P<0.05);两组患者术后即刻、术后3个月、术后12个月其自行排尿情况同时复查最大尿流率比较,差异无统计学意义(t=0.130、0.528、0.298、0.312,P>0.05);术后2周,两组患者生理、心理、社会、环境、独立评分均较治疗前明显升高,且观察组高于对照组,差异有统计学意义(t=13.416、5.429、14.367、9.426、5.529,P<0.05)。结论:直视下尿道内切开术(DVIU)应用200μm钬激光光纤较冷刀不增加并发症,术后患者生活质量更高,评估手术疗效则需要狭窄长度和瘢痕厚度综合考虑。Objective:To evaluate the clinical efficacy of using 200μm holmium laser fiber in the treatment of strictures of urethral bulb or membranous part.Methods:The clinical data of 86 male patients from January,2018 to June,2020 with urethral stricture treated by direct visual internal urethrotomy were analyzed retrospectively.All patients had a stenosed segment that was less than 1 cm and color Doppler ultrasound examination showed scar thickness was less than 0.5 cm.According to surgical methods the patients were divided into two groups.The control group(cold knife group,41 cases):the cold section was used to longitudinally the stenosed section until the junction of scar and normal tissue.The observation group(laser group,45 cases):200μm holmium laser fiber longitudinally cut the narrow section coaxially until the junction of scar and normal tissue.After surgery the 16F silicone catheters were left for 2 weeks,their urination conditions were observed after removed.Results:The operation time of the laser group was longer,intraoperative and during operation loss is less,with statistically significant difference(t=8.494,15.112,14.351,13.300;P<0.05).There was no significant difference between the two groups in self-urination immediately after surgery,3 months after surgery,12 months after surgery and maximum urine flow rate(t=0.130,0.528,0.298,0.312;P>0.05).After two weeks surgery,the physiological,psychological,social,environmental and independent scores of patients in both groups were significantly higher than before surgery,and the observation group was higher than the control group,with statistically significant difference(t=13.416,5.429,14.367,9.426,5.529;P<0.05).Conclusion:The use of fine 200μm holmium laser fiber optic urethrotomy does not increase complications,and the postoperative quality of life is higher than that of cold knife.The evaluation of surgical efficacy requires comprehensive consideration of narrow length and scar thickness.

关 键 词：尿道内切开 200μm钬激光光纤 球、膜部尿道狭窄 冷刀 疗效 

分 类 号：R695[医药卫生—泌尿科学]