發(fā)布時間：2018-07-13 14:35

【摘要】：目的： 探討球囊擴張器聯(lián)合鈥激光治療尿道狹窄的臨床療效及安全性,以及手術(shù)效果的影響因素。 方法： 回顧性分析自2012年9月2014年2月,我院使用球囊擴張器聯(lián)合鈥激光治療50例尿道狹窄患者的過程。通過記錄和監(jiān)測患者尿道狹窄類型、手術(shù)時間、術(shù)中出血量、術(shù)后并發(fā)癥、術(shù)后導尿管留置時間、IPSS評分、QQL評分、最大尿流率(Qmax)、治愈率等相關(guān)臨床指標,并進行統(tǒng)計學分析,評估該手術(shù)方式治療尿道狹窄的療效,并對該手術(shù)的圍手術(shù)期準備、手術(shù)方法、術(shù)中注意事項、術(shù)后并發(fā)癥的發(fā)生原因及防治等進行經(jīng)驗總結(jié)。 結(jié)果： 本組36例患者一次性手術(shù)成功,手術(shù)時間20min-70min,平均45.7±4.8min,術(shù)中出血量5-20ml,平均10ml,術(shù)后拔管時間為3-29d,平均(20.7±4.2)d,首次拔管后均排尿通暢,無尿潴留發(fā)生,復(fù)查Qmax平均(21.4±4.4)ml/s, IPSS平均(8.7±2.3),QOL平均(1.3士0.5)較術(shù)前有顯著性差別(P0.05),術(shù)后第3個月復(fù)查Qmax平均(20.3±4.2) ml/s, IPSS平均(8.1士1.6),QOL平均(1.0±0.4),術(shù)后第6個月Qmax平均(19.6±3.7)ml/s, IPSS平均(8.4±2.3),QOL平均(1.5士0.2)。進行為期3-17個月的隨訪觀察,49例患者隨訪至今,失訪1例,其中X1cm的患者11例治愈,無復(fù)發(fā)；25例1cm≤X≤3cm的患者中19例治愈或好轉(zhuǎn),6例復(fù)發(fā),其中5例行定期尿道擴張,1例再次行球囊擴張器聯(lián)合鈥激光；13例X3cm的患者中6例治愈或好轉(zhuǎn),7例復(fù)發(fā),其中5例行尿道成形術(shù),1例再次行球囊擴張器聯(lián)合鈥激光。23例單純性尿道狹窄治愈或好轉(zhuǎn)19例,成功率為82.6%；26例復(fù)雜性尿道狹窄治愈或好轉(zhuǎn)17例,成功率為65.4%,二者有明顯差別(P0.05)。·術(shù)后均無尿道出血、尿道穿孔、尿瘺、尿失禁、尿道膀胱結(jié)石等并發(fā)癥發(fā)生。 結(jié)論： 1.球囊擴張器聯(lián)合鈥激光治療尿道狹窄效果滿意,且安全性可靠,并發(fā)癥少,恢復(fù)時間快,值得進一步推廣應(yīng)用。 2.其療效與尿道狹窄的長度相關(guān),Xlcm,球囊擴張器聯(lián)合鈥激光治療效果確切,可作為首選；1cm≤X≤3cm,可先選擇球囊擴張器聯(lián)合鈥激光治療,失敗后可選擇其他治療,如開放手術(shù)；X3cm,應(yīng)選擇開放手術(shù)。 3.球囊擴張器聯(lián)合鈥激光可作為治療單純性尿道狹窄首選方法,對復(fù)雜性尿道狹窄也具有明顯效果。
[Abstract]:Objective: to investigate the clinical efficacy and safety of balloon dilator combined with holmium laser in the treatment of urethral stricture. Methods: 50 patients with urethral stricture were treated with balloon dilator and holmium laser since Feb. 2012. By recording and monitoring the type of urethral stricture, operative time, intraoperative bleeding volume, postoperative complications, postoperative catheter indwelling time, IPSS score and QQL score, maximum uroflow rate (Qmax), cure rate, and so on, statistical analysis was made. To evaluate the curative effect of the surgical treatment of urethral stricture, and summarize the experience of perioperative preparation, operative method, intraoperative matters needing attention, the causes of postoperative complications and the prevention and treatment of postoperative complications. Results: one time operation was successful in 36 patients, the operative time was 20 min-70 min (mean 45.7 鹵4.8 min), the blood loss was 5-20 ml (mean 10 ml), the extubation time was 3-29 days (average 20.7 鹵4.2 d) after the first extubation, there was no urine retention after the first extubation. Qmax and IPSS were (21.4 鹵4.4) ml / s and (8.7 鹵2.3) ml / s, respectively (P 0.05). At the third month after operation, Qmax was (20.3 鹵4.2) ml / s, IPSS was (8.1 鹵1.6) / ml / s (1.0 鹵0.4), Qmax was (19.6 鹵3.7) ml / s and IPSS was (8.4 鹵2.3) 鹵(1.5 鹵0.2) ml / s respectively. 49 cases were followed up for 3-17 months. One case was lost. Among them, 11 cases were cured in X1cm group, and 19 cases were cured or improved in 6 cases of 1cm 鈮，

本文編號：2119716