【摘要】：背景及目的:男性泌尿系統(tǒng)疾病中尿道狹窄是一種比較棘手的泌尿外科疾病,臨床癥狀與前列腺增生等下尿路梗阻性疾病臨床表現(xiàn)類似,治療方法不統(tǒng)一,效果欠佳。目前關于尿道狹窄的治療方法多樣化,大致分為開放手術及經(jīng)尿道腔內(nèi)微創(chuàng)手術兩大類。傳統(tǒng)開放類手術雖然治療尿道狹窄的療效確切無異議,但因其具有開放類手術的共同缺點,即開放手術致傷口創(chuàng)面較大,并發(fā)癥比較多,現(xiàn)在已很少采用。隨著微創(chuàng)技術的發(fā)展,腔內(nèi)微創(chuàng)手術治療尿道狹窄已經(jīng)成為大家公認的首選治療方法。腔內(nèi)切開微創(chuàng)手術治療尿道狹窄的技術包括激光類、電切、冷刀、等離子等等。各類切開技術各有優(yōu)缺點,冷刀及等離子技術止血效果差,致術中出血較多、視野不清晰,腔內(nèi)電切技術精準度差,很容易引起術后二次尿道狹窄;現(xiàn)在上述三項技術因其弊端較多,在治療尿道狹窄手術中已不常用。激光類治療尿道狹窄因其精準、止血及療效好,現(xiàn)在已成為醫(yī)學界治療尿道狹窄的手術首選方式。研究證實2μm激光治療尿道狹窄療效明確,本試驗通過對入組患者一般資料進行分析研究,比較手術前后最大尿流率值的差異,分析2μm(銩)激光手術治療尿道狹窄的安全性,同時隨訪研究患者手術后聯(lián)合口服潑尼松藥物治療尿道狹窄的臨床療效,獲得滿意的成效,為男性尿道狹窄的臨床治療提供新的思路和具體實施方法,對于今后尿道狹窄臨床工作的進行具有指導意義。方法:選取我院近三年來收集的62例男性尿道狹窄患者的一般資料進行對比分析研究,所有入組患者術前常規(guī)檢測最大尿流率(Qmax)、尿道造影,擇期行2μm激光尿道狹窄切開手術,術后留置F20#~22#三腔大氣囊尿管,囑試驗組與對照組患者尿管保留約2月,患者依從性良好,兩組術后每月復查最大尿流率,連續(xù)復查3個月。試驗組術后1周開始行潑尼松口服治療,低劑量5mg/天,連續(xù)口服2月,拔除尿管后藥物減量至1/3片,繼續(xù)維持一周左右,后逐漸停藥,對照組不予潑尼松治療。結果:1、62例患者均行2μm激光腔內(nèi)切開手術,手術均成功完成,術前、術中無并發(fā)癥發(fā)生。2、所有患者術后Qmax與術前比較有顯著統(tǒng)計學差異(P0.01);試驗組與對照組術后患者的排尿時間均比術前有統(tǒng)計學差異(P0.05);術后3月、4月、5月試驗組與對照組Qmax值比較,有統(tǒng)計學差異(P0.05)。3、觀察患者術后排尿癥狀的改善程度、手術是否成功的指標不是最大尿流率的數(shù)值大小,而是最大尿流率術前術后的差值改變。4、試驗組、對照組拔出尿管后,術后隨訪半年,全部排尿通暢,試驗組拔出尿管的時間與對照組比較無明顯統(tǒng)計學差異,尚不能認為保留尿管時間越長越好。5、試驗組術后有2例患者術后出現(xiàn)睪丸炎,有1例試驗組患者術后時間32天時尿管自行拔出,后重新置入尿管,其余患者(包括對照組患者)均無尿失禁,睪丸炎、附睪炎及勃起障礙等并發(fā)癥發(fā)生;術后隨訪過程中,試驗組患者服用潑尼松期間均未引起感染、糖尿病、類cushing綜合征癥狀等副作用。結論:2μm激光手術聯(lián)合潑尼松藥物治療尿道狹窄的安全性及療效性好,值得臨床推廣;最大尿流率(Qmax)數(shù)值在診斷尿道狹窄及術后療效隨訪中具有高靈敏性,建議診療尿道狹窄首選;對于尿道狹窄患者尿管保留時間,是不是時間越長越好,有待進一步研究。
[Abstract]:BACKGROUND & OBJECTIVE: The urethral stricture in male urinary system is a more difficult urological disease. The clinical symptoms are similar to that of the lower urinary tract obstructive diseases such as the prostatic hyperplasia. The treatment method is not uniform and the effect is not good. At present, the method of treatment for urethral stricture is divided into two categories: open surgery and minimally invasive surgery in the transurethral cavity. The traditional open-type operation has no objection to the treatment of urethral stricture, but it has the common drawback of open surgery, that is, the wound surface is large with the open operation, and the complication is much, and it is now very rarely used. With the development of minimally invasive technique, minimally invasive surgery in the cavity for the treatment of urethral stricture has become a generally accepted method of treatment. The technique of minimally invasive surgery for the treatment of urethral stricture includes laser, electric cutting, cold knife, plasma and so on. the various cutting techniques have advantages and disadvantages, the advantages and disadvantages of the cold knife and the plasma technology are poor, the bleeding is more in the operation, the visual field is not clear, the precision of the electric cutting technique in the cavity is poor, the postoperative secondary urethral stricture can be easily caused, It is not commonly used in the treatment of urethral stricture. Laser-based treatment of urethral stricture has become the first choice for the treatment of urethral stricture due to its precise, hemostatic and therapeutic effects. The efficacy of 2. m laser in the treatment of urethral stricture was confirmed. The general data of the patients in the group were analyzed and compared, the difference of the maximum urinary flow rate before and after operation was compared, and the safety of the urethral stricture was analyzed by 2. m At the same time, the clinical effect of combined oral prednisone for the treatment of urethral stricture after the operation of the patients was followed up, and the satisfactory results were obtained. Methods: The general data of 62 cases of male urethral stricture collected in the last three years of our hospital were compared and analyzed. After the operation, the urine tube of the large air bag of the F20 # ~ 22 # 3-chamber was retained. The test group and the control group were instructed to keep the urine tube for about 2 months. The patient's compliance was good. The maximum urine flow rate was re-examined every month after the two groups, and it was continuously reviewed for 3 months. Prednisone oral treatment was started at 1 week after the operation of the test group. The low dose of 5mg/ day was used for continuous oral administration. The drug was reduced to 1/ 3 tablets after the removal of the urine tube, and the treatment was continued for a week or so, and the control group was not treated with prednisone. Results: 1, 62 patients had a 2. m laser cavity incision, and the operation was completed successfully. There was no complication in the operation before operation. The postoperative Qmax of all patients was significantly different from that before operation (P0.01). There was a significant difference between the test group and the control group after operation (P <0.05). There was a significant difference between the test group and the control group (P0.05). The success rate of the operation was not the value of the maximum urinary flow rate, but the difference between the maximum urinary flow rate and the post-operation was changed. There was no significant difference in the time between the test group and the control group, and it was not considered that the longer the time of the retention of the urine tube was. 5. There were 2 cases of orchitis after the operation of the trial group. The urine tube was pulled out by the urine tube at the time of 32 days after the operation of the test group, and then the urine tube was put into the urine tube. The remaining patients (including the control group) had no complications such as urinary incontinence, orchitis, epididymitis and erectile dysfunction. During the follow-up, the patients in the trial group did not cause side effects such as infection, diabetes, and the symptom of cushing's syndrome. Conclusion: The safety and curative effect of 2. m laser combined with prednisone in the treatment of urethral stricture is good, and it is worthy of clinical promotion. The value of the maximum urinary flow rate (Qmax) has high sensitivity in the diagnosis of urethral stricture and postoperative follow-up. It is suggested that the diagnosis and treatment of urethral stricture is the first choice; For urethral stricture, the longer the urine tube retention time, the longer the time is, the better it is to be further studied.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R695

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