经尿道前列腺双极等离子前列腺剜除术中应用尿管气囊扩张法治疗尿道球部狭窄的效果  

The effect of urethral catheter balloon dilation in the treatment of bulbar urethral stricture during transurethral bipolar plasma enucleation of the prostate

作　　者：文代艳 叶红志 袁顺辉[1] 韦海荣[1] Wen Daiyan;Ye Hongzhi;Yuan Shunhui;Wei Hairong(Department of Urology,The Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院泌尿外科,昆明650101

出　　处：《中华泌尿外科杂志》2025年第2期110-113,共4页Chinese Journal of Urology

摘　　要：目的探讨经尿道前列腺双极等离子前列腺剜除术(TUPEP)中应用尿管气囊扩张法治疗尿道球部狭窄的效果。方法回顾性分析2021年1月至2023年1月昆明医科大学第二附属医院收治的65例术中发现合并尿道狭窄的良性前列腺增生(BPH)患者的临床资料,根据术中尿道狭窄处理方法将患者分为常规组32例和尿管组33例。常规组和尿管组的年龄[(61.8±5.8)岁与(63.0±5.0)岁]、体质量指数[(25.0±2.5)kg/m^(2)与(25.8±2.4)kg/m^(2)]、国际前列腺症状评分[(22.6±3.3)分与(23.0±3.7)分]、最大尿流率[(10.8±2.1)ml/s与(9.7±2.6)ml/s]、残余尿量[(108.8±20.6)ml与(100.6±18.9)ml]、前列腺体积[(42.72±4.66)cm 3与(42.99±5.83)cm 3]比较差异均无统计学意义(P>0.05)。两组均行TUPEP,常规组术中使用尿道探子由F18/20逐级扩张至F29;尿管组术中采用F22尿管气囊注水扩张,每次注水0.5 ml,重复操作至F27镜鞘可通过狭窄环,且进镜不受限、达到正常摆动幅度、视野清楚,或注水量达4.0 ml。比较两组扩张后尿道口和镜下出血情况、手术时间、术后留置尿管时间、住院时间、术后至出院期间尿路感染(尿细菌培养阳性)情况,以及术后6个月内尿道狭窄复发(患者自觉尿流变细,且F21膀胱镜未能通过狭窄部位)情况。结果本研究所有手术均顺利完成,术中扩张均顺利。常规组和尿管组的手术时间分别为(144.9±30.1)min和(134.6±29.2)min,差异无统计学意义(P>0.05)。尿管组扩张成功时最大注水量为2.5、3.0、3.5、4.0 ml分别为5例(15.2%)、13例(39.4%)、10例(30.3%)、5例(15.2%)。常规组扩张后5例(15.6%)出现尿道黏膜撕裂,1例(3.1%)形成假道;尿管组仅见滴状出血,无黏膜撕裂或假道形成。常规组和尿管组术后留置尿管时间[(7.3±1.5)d与(6.8±1.5)d]、住院时间[(5.9±1.5)d与(5.3±1.2)d]比较差异无统计学意义(P>0.05)。尿管组术后尿路感染发生率[18.2%(6/33)与34.4%(11/32),P=0.037]和术后6个�Objective To investigate the efficacy of urethral catheter balloon dilation in the treatment of bulbar urethral stricture during transurethral bipolar plasma enucleation of the prostate(TUPEP).Methods A retrospective analysis was conducted on the clinical data of 65 patients with benign prostatic hyperplasia(BPH)complicated by urethral stricture,who were admitted to the Second Affiliated Hospital of Kunming Medical University from January 2021 to January 2023.The patients were divided into two groups based on the intraoperative treatment of urethral stricture:the conventional group(32 cases)and the catheter group(33 cases).There were no significant differences between the conventional group and the catheter group in terms of age[(61.8±5.8)years vs.(63.0±5.0)years],body mass index[(25.0±2.5)kg/m^(2) vs.(25.8±2.4)kg/m^(2)],international prostate symptom score[(22.6±3.3)vs.(23.0±3.7)],maximum urinary flow rate[(10.8±2.1)ml/s vs.(9.7±2.6)ml/s],residual urine volume[(108.8±20.6)ml vs.(100.6±18.9)ml],and prostate volume[(42.72±4.66)cm 3 vs.(42.99±5.83)cm 3](P>0.05).Both groups underwent TUPEP.In the conventional group,urethral dilators were used intraoperatively to gradually expand from F18/20 to F29.In the catheter group,an F22 urethral catheter balloon was used for hydrostatic dilation,with 0.5 ml of water injected each time,and repeated until successful(F27 sheath could pass through the stricture,and the scope could move freely with normal amplitude and clear vision)or until the total injected volume reached 4.0 ml.The following parameters were observed,icluding urethral orifice and endoscopic bleeding after dilation,operation time,postoperative catheter indwelling time,hospital stay,urinary tract infection(positive urine culture)during the postoperative period until discharge,and recurrence of urethral stricture within 6 months postoperatively(patients reported weak urinary stream,and F21 cystoscopy failed to pass through the stricture).Results All surgeries were successfully completed,and intraoperativ

关 键 词：良性前列腺增生 尿道狭窄 气囊扩张术 

分 类 号：R69[医药卫生—泌尿科学]