本文選題：后尿道狹窄 + 尿道狹窄冷刀內(nèi)切開��； 參考：《武漢大學(xué)》2016年博士論文

【摘要】：目的：本研究將經(jīng)尿道等離子柱狀電極聯(lián)合環(huán)狀電極腔內(nèi)治療男性后尿道狹窄與經(jīng)尿道冷刀切開狹窄相比較,評價(jià)經(jīng)尿道等離子柱狀電極聯(lián)合環(huán)狀電極治療男性后尿道狹窄的有效性、安全性及可行性。為推廣經(jīng)尿道等離子柱狀電極聯(lián)合環(huán)狀電極腔內(nèi)治療男性后尿道狹窄的臨床應(yīng)用提供科學(xué)依據(jù)。方法：本研究采用隨機(jī)對照、雙盲,以經(jīng)尿道等離子柱狀電極聯(lián)合環(huán)狀電極治療男性后尿道狹窄為觀察組,以經(jīng)尿道冷刀切開為對照組。對比分析觀察組與對照組術(shù)前術(shù)后的相關(guān)指標(biāo)數(shù)據(jù)。從2013年6月至2015年8月,共計(jì)112例男性后尿道狹窄,其中膜部尿道狹窄101例。前列腺部尿道狹窄11例。隨機(jī)分為觀察組和對照組。觀察組56例：經(jīng)尿道等離子柱狀電極聯(lián)合環(huán)狀電極腔內(nèi)治療。對照組56例：經(jīng)尿道冷刀切開。記錄兩組患者一般情況及術(shù)前尿流率、術(shù)前尿道造影、術(shù)前殘余尿、術(shù)前生活質(zhì)量評分QOL以及術(shù)中并發(fā)癥、手術(shù)時間等。患者在術(shù)后1月、3月、6月、9月及12月行最大尿流率測定及尿道造影。所有的患者在術(shù)后12月行尿道鏡檢查。若術(shù)后隨訪過程中出現(xiàn)尿流率15ml或主觀感覺排尿不暢或尿道造影提示狹窄,則行尿道鏡檢確定有無狹窄。平均隨訪時間13.9個月。整個隨訪過程中,患者最大尿流率≥15 ml/s,主觀感覺無排尿不暢、無排尿困難,且進(jìn)一步行尿道造影及尿道鏡檢未發(fā)現(xiàn)再狹窄,則被評價(jià)為手術(shù)成功。若患者主觀感覺有排尿不暢等排尿困難癥狀,行尿道造影和尿道鏡發(fā)現(xiàn)再狹窄,需要再次手術(shù)治療或長期尿道擴(kuò)張則被評價(jià)為手術(shù)失敗。結(jié)果：1、術(shù)前兩組情況比較：觀察組56例,對照組56例,平均年齡分別為(41.85±6.87；42.65±8.64)歲,差異無統(tǒng)計(jì)學(xué)意義(t=0.325,P0.05)。觀察組和對照組術(shù)前生活質(zhì)量評分分別為(4.5±0.70；4.68±0.80),兩組差異無統(tǒng)計(jì)學(xué)意義(t=0.17,P0.05)。觀察組和對照組術(shù)前平均狹窄長度分別為(13.23±2.48mm；12.45±2.89mm),兩組術(shù)前狹窄長度差異無統(tǒng)計(jì)學(xué)意義。觀察組和對照組術(shù)前平均最大尿流率分別為(4.68±1.88；7.8±1.47 ml/秒),兩組差異無統(tǒng)計(jì)學(xué)意義(t=0.279,P0.05)。術(shù)前觀察組和對照組平均殘余尿分別為(59.86±2.48ml；61.25±2.89ml),差異無統(tǒng)計(jì)學(xué)意義(t=0.78,P0.05)。2、觀察組與對照組手術(shù)時間比較。觀察組與對照組手術(shù)時間分別為(23.45±7.64分鐘vs33.45±5.45分鐘)。觀察組手術(shù)時間短與對照組,差異有統(tǒng)計(jì)學(xué)意義(t=2.25,P0.05)。3、術(shù)中并發(fā)癥情況：兩組患者均未出現(xiàn)因心肺腦血管意外的死亡病例。觀察組未出現(xiàn)明顯大出血、假道、膀胱或直腸損傷。對照組出現(xiàn)一例假道,未出現(xiàn)大出血、膀胱或直腸損傷。4、術(shù)后尿流率比較：觀察組術(shù)后1、3、6、9、及12月平均最大尿流率分別為(19.54±1.78ml/s、18.54±1.74 ml/s、18.32±2.78 ml/s、18.34±1.74ml/s 17.25±2.12ml/s),觀察組術(shù)后隨訪1月、3月、6月及9月最大尿流率保持穩(wěn)定,術(shù)后12月尿流率較術(shù)前1月尿流率略有下降。復(fù)發(fā)集中在術(shù)后12月及以后。對照組1月、3月、6月、9月及12月平均最大尿流率分別為(17.54±2.36ml/s; 17.51±2.26ml/s:16.55±1.15ml/s;14.58±1.36ml/s; 13.54±2.78 ml/s)。對照組術(shù)后1月3及6月最大尿流率保持相對穩(wěn)定,但從術(shù)后9月及12月開始,尿流率逐漸減少,即術(shù)后6月內(nèi)療效穩(wěn)定,但從術(shù)后9月療效逐漸下降。兩組術(shù)后1月3月平均最大尿流率相近,差異無統(tǒng)計(jì)學(xué)意義,術(shù)后6月、9月、12月觀察組最大尿流率明顯好于對照組最大尿流率。差異有統(tǒng)計(jì)學(xué)意義(P0.05)5、術(shù)后生活質(zhì)量評分QOL比較：觀察組術(shù)后1、3、6、9、及12月QOL分別為(2.3±0.8；2.5±0.6;2.5±0.9；2.9±0.7；3.5±0.8分),對照組術(shù)后1、3、6、9、及12月QOL分別為(2.6±0.7；2.5±0.8；2.7±0.8；3.3±0.7；4.5±0.8分)。觀察組術(shù)后隨訪1月、3月、6月及9月QOL保持穩(wěn)定,術(shù)后12月QOL開始下降,與尿流率下降時間同步。對照組術(shù)后1月3及6月QOL保持相對穩(wěn)定,但從術(shù)后9月及12月開始,QOL逐漸下降,亦與尿流率下降同步。6、術(shù)后并發(fā)癥比較：觀察組有一例術(shù)后出現(xiàn)暫時尿失禁,一周后尿失禁癥狀逐漸好轉(zhuǎn)。術(shù)后未發(fā)生嚴(yán)重出血、嚴(yán)重尿路感染、急性附睪炎、永久性尿失禁、勃起功能障礙等嚴(yán)重并發(fā)癥。對照組術(shù)后1例出現(xiàn)急性附睪炎,經(jīng)加強(qiáng)抗感染治療后治愈,未出現(xiàn)嚴(yán)重出血、嚴(yán)重尿路感染、急性附睪炎、永久性尿失禁、勃起功能障礙等嚴(yán)重并發(fā)癥。7、術(shù)后復(fù)發(fā)率比較：觀察組49例患者隨訪過程中未發(fā)現(xiàn)再狹窄,被評價(jià)為“手術(shù)成功”(87.5%)。7例患者通過尿道造影或尿道鏡發(fā)現(xiàn)再狹窄,被評價(jià)為“術(shù)后復(fù)發(fā)”：復(fù)發(fā)率(12.5%)。對照組30例患者未發(fā)現(xiàn)明顯再狹窄,被評價(jià)為“手術(shù)成功”(53.6%)。26例患者在隨訪過程中出現(xiàn)再狹窄,被評價(jià)為“術(shù)后復(fù)發(fā)”(46.4%)。觀察組術(shù)后復(fù)發(fā)率明顯低于對照組,差異有統(tǒng)計(jì)學(xué)意義(t=1.35,P0.01)。結(jié)論：等離子柱狀電極聯(lián)合環(huán)狀電極治療男性后尿道狹窄,相比傳統(tǒng)冷刀狹窄內(nèi)切開,操作簡便,用時少,復(fù)發(fā)率低,無嚴(yán)重并發(fā)癥,安全有效。1、等離子柱狀電極聯(lián)合環(huán)狀電極腔內(nèi)治療后尿道狹窄,不僅可以切割狹窄組織,而且可以汽化瘢痕組織,治療后尿道狹窄所需平均手術(shù)時間少于對照組。2、經(jīng)尿道等離子聯(lián)合環(huán)狀電極腔內(nèi)治療后尿道狹窄,術(shù)中未出現(xiàn)嚴(yán)重出血、假道、及死亡等嚴(yán)重并發(fā)癥者,術(shù)后隨訪未出現(xiàn)永久性尿失禁、嚴(yán)重血尿、勃起功能障礙、急性附睪炎等嚴(yán)重并發(fā)癥。手術(shù)安全。3、經(jīng)尿道等離子聯(lián)合環(huán)狀電極治療后尿道狹窄,因切除瘢痕組織相對較多,通道光滑,術(shù)后尿流率保持穩(wěn)定,復(fù)發(fā)率低。而對照組因冷刀僅僅能切開瘢痕狹窄環(huán),殘余瘢痕組織較多,通道不光滑,術(shù)后復(fù)發(fā)率高。
[Abstract]:Objective: To evaluate the efficacy, safety and feasibility of transurethral plasma columnar electrode combined with annular electrode in the treatment of male posterior urethral stricture by transurethral plasma columnar electrode combined with annular electrode intracavity for the treatment of male posterior urethral stricture and urethral stricture. The clinical application of combined annular electrode intracavity for the treatment of male posterior urethral stricture was provided. Methods: This study was randomized controlled and double blind. The treatment of male posterior urethral stricture by transurethral plasma columnar electrode combined with annular electrode was used as the control group with transurethral resection of the urethra. From June 2013 to August 2015, 112 cases of male posterior urethral stricture, including 101 cases of urethral stricture of the membrane and 11 cases of prostatic urethral stricture, were randomly divided into observation group and control group. 56 cases in observation group were treated with transurethral plasma columnar electrode combined with annular electrode cavity. 56 cases of control group were treated by transurethral cold knife incision. Two groups of patients were recorded in general and preoperative urinary flow rate, preoperative urethrography, preoperative residual urine, preoperative quality of life score QOL, intraoperative complications, and operation time. The patients underwent maximum urinary flow measurement and urethrography in January, March, June, September, and December. All patients underwent urethroscope after surgery in December. Follow up after operation. The urinary flow rate of 15ml or subjective urination or urethral stricture was found in the course of urethral stricture. The urethroscope was performed to determine whether there was stricture. The mean follow-up time was 13.9 months. During the whole follow-up period, the maximum urine flow rate was more than 15 ml/s, the subjective feeling of urination was not smooth, and no urination was difficult, and further urethrography and urethroscope were not found again. Stenosis was evaluated as a successful operation. If the patient had a subjective feeling of dysuria, such as difficulty in urination, urethrography and urethroscope, restenosis, the need for reoperation or long-term urethral dilatation were evaluated as failure. Results: 1, the preoperative two groups were compared: 56 cases in the observation group and 56 cases in the control group, the average age was respectively ( 41.85 + 6.87; 42.65 + 8.64 years old, the difference was not statistically significant (t=0.325, P0.05). The quality of life of the observation group and the control group was (4.5 + 0.70; 4.68 + 0.80), and there was no significant difference between the two groups (t=0.17, P0.05). The average stenosis length of the observation group and the control group was (13.23 + 2.48mm; 12.45 + 2.89mm), respectively, and the preoperative stenosis of the two group. The average maximum urine flow rate in the observation group and the control group was (4.68 + 1.88; 7.8 + 1.47 ml/ seconds), and the two groups were not statistically significant (t=0.279, P0.05). The average residual urine in the observation group and the control group was (59.86 + 2.48ml; 61.25 + 2.89ml), and the difference was not statistically significant (t=0.78, P0.05).2, the observation group Compared with the control group, the operation time of the observation group and the control group was (23.45 + 7.64 minutes vs33.45 + 5.45 minutes). The operation time of the observation group was short and the control group, the difference was statistically significant (t=2.25, P0.05).3, the complications in the operation: the two groups of patients had no fatal cases of cardiovascular and cerebrovascular accidents. The observation group did not appear in the observation group. Significant hemorrhage, false path, bladder or rectal injury. In the control group, there was a case of false path, without massive hemorrhage, bladder or rectal injury.4, and the postoperative urinary flow rate was compared: the postoperative 1,3,6,9, and the average maximum urine flow rate in the observation group were (19.54 + 1.78ml/s, 18.54 + 1.74 ml/s, 18.32 + 2.78 ml/s, 18.34 + 1.74ml/s 17.25 + 2.12ml/s), and the observation group after operation. The maximum urine flow rate remained stable in January, March, June and September. The urine flow rate in December was slightly lower than that before the operation in January. The recurrence rate was in December and after the operation. The average maximum urine flow rate was (17.54 + 2.36ml/s; 17.51 + 2.26ml/s:16.55 + 1.15ml/s; 14.58 + 1.36ml/s; 13.54 + 2.78 ml/s). The maximum urine flow rate in the control group was relatively stable in 3 and June January, but the urine flow rate decreased gradually from September and December after the operation, that is, the curative effect was stable in June, but the curative effect decreased gradually from September. The average maximum urine flow rate in the two groups was similar in January. The maximum urine flow rate was better than that of the control group (P0.05) 5, and the postoperative quality of life score QOL was compared: the postoperative 1,3,6,9 of the observation group and the December QOL were (2.3 + 0.8; 2.5 + 0.6; 2.5 + 0.9; 2.9 + 0.7; 3.5 +), and the control group was 1,3,6,9 and December QOL respectively. After operation, the observation group was followed up in January, March, June and September, QOL remained stable, and December QOL began to decrease in December and to synchronize with the decrease of urine flow rate. In the control group, 3 and June QOL remained relatively stable, but the QOL gradually declined after the operation and began to synchronize.6 with the decrease of urine flow rate, and the postoperative complications were compared: the observation group had one case after operation. There was no severe bleeding, severe urinary tract infection, acute epididymitis, permanent incontinence, erectile dysfunction and other serious complications. 1 cases of acute epididymitis in the control group, cured after strengthening anti infection treatment, no severe bleeding, severe urinary tract infection, acute Severe complications, such as epididymitis, permanent incontinence and erectile dysfunction,.7, the postoperative recurrence rate was compared: 49 patients in the observation group did not find restenosis during the follow-up process, and were evaluated as "surgical success" (87.5%).7 patients were restenosis after urethrography or urethroscope, and the recurrence rate (12.5%) was evaluated as the recurrence rate (12.5%). 30 patients had no obvious restenosis and were evaluated as "successful operation" (53.6%).26 patients had restenosis during the follow-up process and were evaluated as "postoperative recurrence" (46.4%). The postoperative recurrence rate of the observation group was significantly lower than that of the control group (t=1.35, P0.01). Conclusion: plasma columnar electrode combined with annular electrode for the treatment of men. Sexual posterior urethral stricture, compared with the traditional cold knife narrow incision, simple operation, less time, low recurrence rate, no serious complications, safe and effective.1, plasma columnar electrode combined with annular electrode intracavity treatment of posterior urethral stricture, not only can cut the narrow tissue, but also can vaporized scar tissue, the average operation time for the treatment of posterior urethral stricture Less than the control group.2, the urethral stricture of the urethra combined with the transurethral plasma plasma combined with annular electrode, no severe bleeding, false or dead complications during the operation, there were no permanent urinary incontinence, severe hematuria, erectile dysfunction, acute epididymitis and other serious complications after operation. Surgical safety of.3, transurethral plasma plasma combined ring After the treatment of urethral stricture after the electrode treatment, the resection of scar tissue is relatively more, the channel is smooth, the urine flow rate remains stable after operation, and the recurrence rate is low. And the control group only can cut the scar narrow ring because of the cold knife, the residual scar tissue is more, the channel is not smooth and the recurrence rate is high after the operation.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R699.6

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