【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(guān)于尿道狹窄的治療方法多樣化,大致分為開放手術(shù)及經(jīng)尿道腔內(nèi)微創(chuàng)手術(shù)兩大類。傳統(tǒng)開放類手術(shù)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(shù)的共同缺點(diǎn),即開放手術(shù)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(shù)的發(fā)展,腔內(nèi)微創(chuàng)手術(shù)治療尿道狹窄已經(jīng)成為大家公認(rèn)的首選治療方法。腔內(nèi)切開微創(chuàng)手術(shù)治療尿道狹窄的技術(shù)包括激光類、電切、冷刀、等離子等等。各類切開技術(shù)各有優(yōu)缺點(diǎn),冷刀及等離子技術(shù)止血效果差,致術(shù)中出血較多、視野不清晰,腔內(nèi)電切技術(shù)精準(zhǔn)度差,很容易引起術(shù)后二次尿道狹窄;現(xiàn)在上述三項(xiàng)技術(shù)因其弊端較多,在治療尿道狹窄手術(shù)中已不常用。激光類治療尿道狹窄因其精準(zhǔn)、止血及療效好,現(xiàn)在已成為醫(yī)學(xué)界治療尿道狹窄的手術(shù)首選方式。研究證實(shí)2μm激光治療尿道狹窄療效明確,本試驗(yàn)通過對入組患者一般資料進(jìn)行分析研究,比較手術(shù)前后最大尿流率值的差異,分析2μm(銩)激光手術(shù)治療尿道狹窄的安全性,同時隨訪研究患者手術(shù)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(shí)施方法,對于今后尿道狹窄臨床工作的進(jìn)行具有指導(dǎo)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(jìn)行對比分析研究,所有入組患者術(shù)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(shù),術(shù)后留置F20#~22#三腔大氣囊尿管,囑試驗(yàn)組與對照組患者尿管保留約2月,患者依從性良好,兩組術(shù)后每月復(fù)查最大尿流率,連續(xù)復(fù)查3個月。試驗(yàn)組術(shù)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(jié)果:1、62例患者均行2μm激光腔內(nèi)切開手術(shù),手術(shù)均成功完成,術(shù)前、術(shù)中無并發(fā)癥發(fā)生。2、所有患者術(shù)后Qmax與術(shù)前比較有顯著統(tǒng)計(jì)學(xué)差異(P0.01);試驗(yàn)組與對照組術(shù)后患者的排尿時間均比術(shù)前有統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后3月、4月、5月試驗(yàn)組與對照組Qmax值比較,有統(tǒng)計(jì)學(xué)差異(P0.05)。3、觀察患者術(shù)后排尿癥狀的改善程度、手術(shù)是否成功的指標(biāo)不是最大尿流率的數(shù)值大小,而是最大尿流率術(shù)前術(shù)后的差值改變。4、試驗(yàn)組、對照組拔出尿管后,術(shù)后隨訪半年,全部排尿通暢,試驗(yàn)組拔出尿管的時間與對照組比較無明顯統(tǒng)計(jì)學(xué)差異,尚不能認(rèn)為保留尿管時間越長越好。5、試驗(yàn)組術(shù)后有2例患者術(shù)后出現(xiàn)睪丸炎,有1例試驗(yàn)組患者術(shù)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(shù)后隨訪過程中,試驗(yàn)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(jié)論:2μm激光手術(shù)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(shù)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(jìn)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(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R695

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉昭輝;洪哲;羅華榮;向振東;吳登龍;;尿道狹窄術(shù)后復(fù)發(fā)的相關(guān)危險(xiǎn)因素評估[J];同濟(jì)大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2016年04期

2 魯守琳;景德善;王養(yǎng)民;魯守會;;雙鏡聯(lián)合鈥激光治療后尿道狹窄的臨床分析[J];中國男科學(xué)雜志;2015年07期

3 高宏飛;王東文;曹曉明;;最大自由尿流率和殘余尿在良性前列腺增生評估中的臨床意義[J];中華泌尿外科雜志;2013年08期

4 顏廷帥;劉祚君;劉永紅;舒鐵環(huán);;鈥激光聯(lián)合等離子電切治療后尿道狹窄與傳統(tǒng)開放手術(shù)的療效比較[J];白求恩軍醫(yī)學(xué)院學(xué)報(bào);2013年03期

5 李凈;;糖皮質(zhì)激素聯(lián)合維生素C、維A酸減輕瘢痕形成[J];中外醫(yī)療;2012年18期

6 李義;馬亞東;靳永勝;任濤;;117例男性尿道狹窄的病因分析及防治[J];中國男科學(xué)雜志;2012年02期

7 馮瑞;沈斌;李中興;葛廣成;吳丹;王星;崔彥;;綠激光治療尿道狹窄臨床療效觀察[J];實(shí)用醫(yī)學(xué)雜志;2011年16期

8 姜帥;王國民;;激光在泌尿外科疾病中應(yīng)用的新進(jìn)展[J];國際泌尿系統(tǒng)雜志;2011年03期

9 王靖軍;;兩種尿流率檢查方法診斷女性排尿功能障礙的臨床意義[J];重慶醫(yī)學(xué);2009年24期

10 張爭;張祥華;李昕;李淑清;;中老年男性前列腺體積和最大尿流率的相關(guān)性分析[J];中華臨床醫(yī)師雜志(電子版);2009年09期

相關(guān)碩士學(xué)位論文 前2條

1 任耀強(qiáng);經(jīng)尿道2μm激光治療外傷性尿道狹窄與閉鎖的應(yīng)用研究[D];山西醫(yī)科大學(xué);2014年

2 王周;最大尿流率變化值檢測在判斷尿道狹窄中的應(yīng)用價值[D];蘇州大學(xué);2014年

，

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