优路铥激光结合曲安奈德腔内注射治疗尿道吻合术失败病例的疗效观察  

Pulsed thulium laser combined with pulsed thulium laser injection for the treatment of failed urethral anastomosis

作　　者：李健[1] 郑大超[2] 姚海军[2] 黄金 蔡忠林 蔡志康 沈彦婷 王忠 LI Jian;ZHENG Da-chao;YAO Hai-jun;HUANG Jin;CAI Zhong-lin;CAI Zhi-kang;SHEN Yan-ting;WANG Zhong(Department of Urology and Andrology,Gongli Hospital of Shanghai Pudong New Area,Shanghai 200135,China;Department of Urology,Shanghai Ninth Peoples Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200041,China)

机构地区：[1]上海市浦东新区公利医院泌尿外科男科学部,上海200135 [2]上海交通大学医学院附属第九人民医院泌尿外科,上海200041

出　　处：《中华男科学杂志》2024年第5期419-423,共5页National Journal of Andrology

基　　金：浦东新区卫生系统医学学科建设项目(PYWgf2021-06);浦东新区中医药传承创新发展示范试点项目浦东新区中西医协同旗舰科室(泌尿外科)建设计划(YC-2023-0405)。

摘　　要：目的:探讨优路铥激光结合曲安奈德腔内注射治疗尿道吻合术失败病例的临床经验。方法:回顾性分析2018年1月至2023年12月收治的盆腔骨折尿道牵张性缺损(PFUDD)男性患者。共纳入尿道吻合术失败患者35例,根据内切开能量平台分别为优路铥激光和等离子组。所有患者均在直视下尿道狭窄内切开术,并予以曲安奈德腔内局部注射,记录年龄、狭窄长度、手术时间、术前最大尿流率、术后最大尿流率、术后并发症以及狭窄复发情况。结果:所有患者均顺利完成所有治疗,两组患者在年龄、狭窄长度、手术时间、并发症率及狭窄复发率上均无统计学差异(P>0.05)。铥激光组和等离子组中位随访时间分别为21.0个月(IQR 16.0~24.0)和21.0个月(IQR 17.0~25.0),术前和术后12个月的最大尿流率均有显著差异(P<0.01)。两组无复发生存期无统计学差异(P=0.398)。结论:优路铥激光尿道内切开结合曲安奈德腔内局部注射在短期内可有效维持尿道狭窄瘢痕的稳定,保持良好的尿道通畅性。与传统等离子内切开相比,该策略术后并发症率较低,具有操作简单、安全、并发症少、疗效可靠等特点,可作为PFUDD患者吻合术失败后的补救治疗方法。Objective:To investigate the clinical effect of pulsed thulium laser(PTL)combined with triamcinolone acetonide injection in the treatment of failed posterior urethral anastomosis(FPUA).Methods:This retrospective study included 35 male patients treated in Gongli Hospital for failed posterior urethral anastomosis from January 2018 to December 2023.All the patients underwent direct-vision internal urethrotomy(DVIU)with transurethral PTL(the PTL group,n=15)or transurethral plasma(the TUP group,n=20),and all received intralesional injection of triamcinolone acetonide.We followed up the patients for a median of 21 months,recorded the age,length of urethral stricture,operation time,pre-and post-operative maximum urinary flow rate(Qmax),postoperative complications and recurrence of urethral stricture,and compared the data obtained between the two groups.Results:All the patients smoothly completed the treatment procedures.No statistically significant differences were observed in the age,length of urethral stricture,operation time and postoperative complications between the two groups(P>0.05).The median follow-up time for the thulium laser group and plasma group was 21.0 months(IQR 16.0-24.0)and 21.0 months(IQR 17.0-25.0),respectively,with a statistically significant difference observed in the maximum urine flow rate before and after surgery at the 12-month mark(P<0.01).No significant disparity was found in terms of relapse-free survival between the two groups(P=0.398)Conclusion:Pulsed thulium laser combined with triamcinolone acetonide injection can effectively maintain a short-term cicatricial stability of the urethral stricture and satisfactory urethral patency,obviously superior to plasmotomy as a remedial treatment of urethral stricture after failed posterior urethral anastomosis.

关 键 词：优路铥激光 等离子 盆腔骨折尿道牵张性缺损 尿道吻合术 

分 类 号：R699.6[医药卫生—泌尿科学]