本文選題：輸尿管鏡 + 鈥激光��； 參考：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：[目的] 通過(guò)輸尿管鏡鈥激光與冷刀內(nèi)切開(kāi)術(shù)治療男性單純性尿道狹窄的比較來(lái)評(píng)價(jià)兩種術(shù)式的臨床療效。 [方法] 回顧性分析自2008年1月至2013年2月在山西省運(yùn)城市中心醫(yī)院行微創(chuàng)手術(shù)治療的68例男性單純性尿道狹窄患者,其中行輸尿管鏡下鈥激光治療37例(A組),行冷刀內(nèi)切開(kāi)治療31例(B組)。收集和記錄兩組患者術(shù)前、術(shù)中及術(shù)后的相關(guān)臨床指標(biāo),包括一般資料(年齡、部位、長(zhǎng)度、術(shù)前最大尿流率)、手術(shù)時(shí)間、術(shù)中出血量、術(shù)中并發(fā)癥、術(shù)后最大尿流率(Qmax)、術(shù)后尿道擴(kuò)張次數(shù)、復(fù)發(fā)例數(shù)、再手術(shù)例數(shù)、術(shù)后并發(fā)癥,并進(jìn)行統(tǒng)計(jì)學(xué)分析,比較兩組的臨床療效。 [結(jié)果] 1.A組(鈥激光組)和B組(冷刀組)治療男性單純性尿道狹窄的手術(shù)時(shí)間分別為38.1±8.7min、20.3±5.5min；A組(鈥激光組)和B組(冷刀組)術(shù)中出血量分別為19.8±5.8m1、31.3±8.5m1。兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 2.術(shù)后A組獲隨訪患者34例,隨訪時(shí)間4-30個(gè)月,平均14月,術(shù)后平均擴(kuò)尿道次數(shù)11.1±3.1次,術(shù)后平均最大尿流率19.2±3.4ml/s,復(fù)發(fā)6例(17.6%),再次手術(shù)者3例(8.8%)；B組獲隨訪患者28例,隨訪時(shí)間6～35個(gè)月,平均16月,術(shù)后平均擴(kuò)尿道次數(shù)16.1±4.9次,術(shù)后平均最大尿流率15.1±2.9ml/s,復(fù)發(fā)9例(32.1%),再次手術(shù)者6例(24.1%)。兩組間在術(shù)后最大尿流率、術(shù)后擴(kuò)尿道次數(shù)、復(fù)發(fā)率、再手術(shù)率方面比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 3.A組術(shù)中無(wú)尿外滲病例發(fā)生,術(shù)后無(wú)尿失禁病例出現(xiàn)；B組術(shù)中有2例尿外滲病例,術(shù)后有1例尿失禁病例發(fā)生。 [結(jié)論] 輸尿管鏡鈥激光治療男性單純性尿道狹窄安全有效,可重復(fù),手術(shù)出血少,大大降低了復(fù)發(fā)率和再手術(shù)率,比經(jīng)尿道冷刀內(nèi)切開(kāi)治療效果好,但手術(shù)時(shí)間較長(zhǎng)。
[Abstract]:[purpose] To evaluate the clinical efficacy of ureteroscopic holmium laser and cold knife endotomy in the treatment of male simple urethral stricture. [methods] From January 2008 to February 2013, 68 male patients with simple urethral stricture underwent minimally invasive surgery in Yuncheng Central Hospital of Shanxi Province. Among them, 37 cases of group A were treated with holmium laser under ureteroscope, and 31 cases of group B were treated with cold knife incision. To collect and record the clinical data of the patients before, during and after operation, including general data (age, location, length, preoperative maximum urinary flow rate, operative time, intraoperative bleeding volume, intraoperative complications). The maximum postoperative urinary flow rate (Qmax), the number of urethral dilatation, recurrence, reoperation and postoperative complications were analyzed statistically, and the clinical effects of the two groups were compared. [results] 1. The operative time of simple urethral stricture in group A (holmium laser group) and group B (cold knife group) was 38.1 鹵8.7 min and 20.3 鹵5.5 min respectively. The intraoperative bleeding in group A (holmium laser group) and group B (cold knife group) were 19.8 鹵5.8m1m-1 and 31.3 鹵8.5m1respectively. The difference between the two groups was statistically significant (P 0.05). 2. In group A, 34 patients were followed up for 4-30 months (mean 14 months), the average number of urethral dilatation was 11.1 鹵3.1, the average maximum flow rate was 19.2 鹵3.4 ml / s, and the recurrence rate was 17.6%. In group B, 28 cases were followed up, and the follow-up time ranged from 6 months to 35 months. The average number of urethral dilatation was 16.1 鹵4.9, the mean maximum flow rate was 15.1 鹵2.9 ml / s, the recurrence was 32.1ml / s, and the second operation was 24.1ml / s. There were significant differences between the two groups in terms of the maximum urinary flow rate, the number of urethral dilatation, the recurrence rate and the reoperation rate (P 0.05). 3. In group A, there were no cases of exosmosis during operation, two cases of exosmosis in group B and one case of urinary incontinence after operation. [conclusion] Ureteroscopic holmium: YAG laser in the treatment of male simple urethral stricture is safe, effective, repeatable, and less bleeding. It greatly reduces the recurrence rate and reoperation rate, which is better than that of transurethral cold knife incision, but the operation time is longer.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.6

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