【摘要】：目的：探討2微米激光治療女性尿道肉阜止血的效果和機(jī)制，評估2微米激光治療女性尿道肉阜的療效及安全性，，探索2微米激光治療女性尿道肉阜術(shù)后無管化的可行性。 方法：前瞻性研究貴州省人民醫(yī)院2010年1月至2014年1月行2微米激光女性尿道肉阜切除患者20例。回顧性研究貴州省人民醫(yī)院2005年12月至2013年12月行常規(guī)女性尿道肉阜切除患者20例（其中高頻電刀切除10例，手術(shù)刀切除10例）。經(jīng)2微米激光及高頻電刀切除術(shù)后的尿道肉阜組織標(biāo)本，應(yīng)用HE染色光鏡下觀察尿道肉阜切緣組織形態(tài)學(xué)改變。比較2微米激光尿道肉阜切除術(shù)與常規(guī)尿道肉阜切除術(shù)的手術(shù)時間、術(shù)中出血量、留置尿管時間、術(shù)后住院時間和無管化率。分別采用視覺模擬評分法（VisualAnalogue Scale/Score，VAS)和膀胱過度活動癥評分法（Overactivity Bladder Symptom Score，OABSS)對兩組患者圍手術(shù)期疼痛和尿路刺激癥狀進(jìn)行評估。比較兩組患者在術(shù)后有無尿潴留、出血、疼痛、排尿困難、尿道外口狹窄、尿道陰道瘺和復(fù)發(fā)情況。 結(jié)果：（1）與高頻電刀尿道肉阜切除術(shù)相比，2微米激光術(shù)后尿道肉阜組織切緣更平滑，焦痂更小，形成的凝固層更淺；2微米激光和高頻電刀均通過組織凝固，血管收縮閉合而起到止血效果，但2微米激光凝固層內(nèi)血管收縮更明顯，管腔內(nèi)未見紅細(xì)胞，而高頻電刀凝固層內(nèi)部分血管擴(kuò)張，管腔內(nèi)見大量紅細(xì)胞。 （2）2微米激光組與常規(guī)手術(shù)組的手術(shù)時間分別為5.3±1.03min和14.4±3.14min，兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）；留置尿管時間分別為0.25±0.79d和4.05±1.19d，兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）；術(shù)中出血量分別為3.71±1.04ml和11.03±2.59ml，兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）；術(shù)后住院時間分別為2.2±0.52d和4.5±1.0d，兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）。2微米激光組術(shù)后僅有2例留置尿管，無管化率為90%（18/20），而常規(guī)手術(shù)組術(shù)后均留置尿管，無管化率為0（0/20），兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）。 （3）2微米激光組與較常規(guī)手術(shù)組術(shù)前VAS評分分別為1.45±1.28（0～4）和1.55±1.64（0～4），兩組比較，差異無統(tǒng)計學(xué)意義（P=0.804）；兩組術(shù)畢VAS評分分別為1.60±0.88（0～3）和3.80±0.83（2～5），兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）；兩組術(shù)后24小時VAS評分分別為0.95±0.99（0～3）和3.05±0.89（2～4），兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）。2微米激光組與常規(guī)手術(shù)組術(shù)前OABSS總評分分別為0.50±0.83（0～2）和1.00±1.17（0～3），兩組比較，差異無統(tǒng)計學(xué)意義（P=0.188）；兩組術(shù)后24小時OABSS總評分分別為0.7±1.3（0～3）和4.25±0.91（3～6），兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）；兩組術(shù)后2天OABSS總評分分別為0.35±0.88（0～3）和3.7±0.86（3～5），兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）；兩組術(shù)后3天OABSS總評分分別為0.00±0.00（0～0）和2.7±1.08（0～5），兩組比較，差異有統(tǒng)計學(xué)意義（P＜0.05）。 （4）2微米激光組無術(shù)后出血，常規(guī)手術(shù)組有5例術(shù)后出血；2微米激光組有2例術(shù)后初期排尿疼痛，常規(guī)手術(shù)組有3例術(shù)后初期排尿疼痛；2微米激光組無排尿困難，常規(guī)手術(shù)組有1例出現(xiàn)排尿困難。2微米激光組20例患者均一次治療后達(dá)到痊愈標(biāo)準(zhǔn)；常規(guī)手術(shù)組有1例10個月后肉阜復(fù)發(fā)，進(jìn)行了二次手術(shù)。 結(jié)論：（1）2微米激光治療女性尿道肉阜的止血機(jī)制是激光導(dǎo)致組織血管凝固收縮； （2）與常規(guī)尿道肉阜切除術(shù)相比，2微米激光尿道肉阜切除術(shù)療效更好，安全性可靠； （3）2微米激光治療女性尿道肉阜術(shù)后無管化是可行的。
[Abstract]:Objective: To explore the effect and mechanism of 2 micron laser treatment for female urethral caruncle hemostasis, evaluate the efficacy and safety of 2 micron laser in the treatment of female urethral caruncle, and explore the feasibility of 2 micron laser for the treatment of female urethral caruncle.
Methods: 20 cases of 2 micron laser female urethral caruncle resection in Guizhou People's Hospital from January 2010 to January 2014 were prospectively studied. 20 cases of normal female urethral caruncle resection from December 2005 to December 2013 were retrospectively studied (of which 10 cases were cut by high frequency electric knife and 10 cases with surgical knife resection). 2 micron laser was used. The tissue morphology of urethra caruncle after the resection of high frequency electroknife was used to observe the histomorphological changes of the caruncle edge of the urethra by HE staining. The operative time of 2 micron laser urethral caruncle resection and conventional urethral caruncle resection, intraoperative bleeding, indwelling catheter time, postoperative hospitalization time and non tube rate were compared. VisualAnalogue Scale/Score (VAS) and urinary bladder hyperactivity syndrome (Overactivity Bladder Symptom Score, OABSS) were used to evaluate the perioperative pain and urinary tract irritation symptoms in two groups. Compared to the two groups, there were no urinary retention, bleeding, pain, dysuria, urethral stricture, urethral vaginal fistula and recovery after operation. Situation.
Results: (1) compared with the high frequency electroknife urethral caruncle resection, the cutting edge of caruncle tissues of the urethra was smoother after 2 micron laser surgery, the eschar was smaller and the solidified layer formed more shallow; the 2 micron laser and high frequency electric knife all solidified by tissue, and the vasoconstriction closed to the hemostatic effect, but the blood vessel contraction in the 2 micron laser solidified layer was more obvious in the lumen and the lumen inside the lumen No red blood cells were found, while some of the vessels in the coagulation layer of the high frequency electrocautery were dilated and a large number of red blood cells were seen in the lumen.
(2) the operation time of the 2 micron laser group and the conventional operation group was 5.3 + 1.03min and 14.4 + 3.14min respectively. The difference between the two groups was statistically significant (P < 0.05); the indwelling catheter time was 0.25 + 0.79d and 4.05 + 1.19d respectively. The difference between the two groups was statistically significant (P < 0.05), and the intraoperative bleeding volume was 3.71 + 1.04ml and 11.03 + 2.59ml, two, two. The difference was statistically significant (P < 0.05); the postoperative hospitalization time was 2.2 0.52d and 4.5 1.0d respectively. The two groups were statistically significant (P < 0.05) there were only 2 indwelling urethral catheters in.2 micron laser group and 90% (18/20) without catheterization in the routine operation group, and the rate of catheterization was 0 (0/20) after operation in the routine operation group. The difference between the two groups was different. The difference was the difference between the two groups. There were statistical significance (P < 0.05).
(3) the preoperative VAS score of the 2 micron laser group was 1.45 + 1.28 (0~4) and 1.55 + 1.64 (0~4), respectively. There was no significant difference in the two groups (P=0.804). The two group VAS scores were 1.60 + 0.88 (0~3) and 3.80 +. The difference was statistically significant (P The difference was 0.95 + 0.99 (0~3) and 3.05 + 0.89 (2~4) respectively. The difference was statistically significant (P < 0.05) and the total OABSS score of.2 micron laser group and routine operation group was 0.50 + 0.83 (0~2) and 1 + 1.17 (0~3), and the difference was not statistically significant (P=0.188). To 3 and 4.25 + 0.91 (3~6), the difference between the two groups was statistically significant (P < 0.05), and the total OABSS score of the two groups was 0.35 + 0.88 (0~3) and 3.7 + 0.86 (3~5), respectively, and the difference was statistically significant (P There were statistical significance (P < 0.05).
(4) there were no postoperative bleeding in the 2 micron laser group and 5 cases of postoperative bleeding in the routine operation group; 2 cases of postoperative urination pain in the 2 micron laser group, 3 cases of early posturination pain in the routine operation group, no dysuria in the 2 micron laser group, and 1 cases of.2 micron laser in the routine operation group, 20 patients were recovered after a uniform treatment. There were 1 cases in the routine operation group who relapsed after 10 months, and two operations were performed.
Conclusion: (1) the mechanism of 2 micron laser treatment of female urethra caruncle is the coagulation and contraction of blood vessels caused by laser.
(2) compared with routine urethral caruncle resection, 2 micron laser urethral caruncle resection is better and safe.
(3) it is feasible to treat the female urethra caruncle with 2 micron laser.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R699.7

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