耻骨上经膀胱输尿管镜顺行引导治疗尿道后尿道瓣膜及闭锁(附6例报告)
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摘要
目的:通过耻骨上经膀胱输尿管镜顺行引导治疗后尿道瓣膜及闭锁,为临床工作开辟一条新途径。临床资料:本组6例病人均为男性,年龄26岁-72岁,平均年龄40.5岁。除一位72岁老人前列腺增生术后后尿道瓣膜一直寻求治疗外,其它五位病人均已留置膀胱造瘘管多年,基本已放弃治疗。方法:入选的患者均经膀胱输尿管镜顺行引导建立标记,以钬激光建立通道,然后以等离子体刀进行瘢痕汽化进一步扩大尿道腔,直至电切镜鞘通过狭窄段,最后留置F18-22#三腔尿管三周,拔除尿管后定期扩张。结果:6例病人经治疗后均予以定期尿道扩张,随访1-9年,均恢复正常排尿。结论:我们认为耻骨上经膀胱输尿管镜顺行引导治疗后尿道瓣膜及闭锁的方法,可以大大提高手术成功率,标记或通道建立后应当尽量采取等离子汽化治疗,可提高病人的远期疗效。因此我们认为耻骨上经膀胱输尿管镜顺行引导治疗后尿道瓣膜及闭锁,解决了后尿道瓣膜及尿道闭锁治疗中的难题,为临床工作开辟了一条新途径,是值得推广的方法。
Objective:To open up a new way for clinical work through suprapubic ureteroscopy antegrade guide treatment of posterior urethral valves and atresia.Clinical data:The group of 6 patients were male,age 26 years old-72 years old,the average age was 40.5 years.Except for a 72 years old man with posterior urethral valves had been seeking treatment after prostatectomy,the other 5 patients had been indwelling bladder fistula for years and basically abandoned clinical treatment.Methods:All the selected patients with posterior urethral valves and atresia were established markers by suprapubic ureteroscopy antegrade guide,ues holmium laser to establish channels,then use plasma knife scar vaporization to further expand the urethral lumen,until the resectoscope sheath through the narrow section.F18-22 # three cavity catheter was indwelled for three weeks,with regular urethral dilation after removal of catheter.Results:All 6 patients after treatment were performed regular urethral dilatation,followed up for 1-9 years,all patients were restored to normal urination.Conclusion:We conclude that the suprapubic ureteroscopy antegrade guide treatment of posterior urethral valves and atresia can greatly improve the success rate of operation.Plasma vaporization treatment shall be taken after establishment of markers or channels.This may improve the patient's long-term efficacy.So we believe suprapubic ureteroscopy antegrade guide treatment of posterior urethral valves and atresia solves the problems in the treatment of posterior urethral valves and atresia,which opens up a new way for clinical work and is worth popularizing.
Objective:To open up a new way for clinical work through suprapubic ureteroscopy antegrade guide treatment of posterior urethral valves and atresia.Clinical data:The group of 6 patients were male,age 26 years old-72 years old,the average age was 40.5 years.Except for a 72 years old man with posterior urethral valves had been seeking treatment after prostatectomy,the other 5 patients had been indwelling bladder fistula for years and basically abandoned clinical treatment.Methods:All the selected patients with posterior urethral valves and atresia were established markers by suprapubic ureteroscopy antegrade guide,ues holmium laser to establish channels,then use plasma knife scar vaporization to further expand the urethral lumen,until the resectoscope sheath through the narrow section.F18-22 # three cavity catheter was indwelled for three weeks,with regular urethral dilation after removal of catheter.Results:All 6 patients after treatment were performed regular urethral dilatation,followed up for 1-9 years,all patients were restored to normal urination.Conclusion:We conclude that the suprapubic ureteroscopy antegrade guide treatment of posterior urethral valves and atresia can greatly improve the success rate of operation.Plasma vaporization treatment shall be taken after establishment of markers or channels.This may improve the patient's long-term efficacy.So we believe suprapubic ureteroscopy antegrade guide treatment of posterior urethral valves and atresia solves the problems in the treatment of posterior urethral valves and atresia,which opens up a new way for clinical work and is worth popularizing.
引文
[1]傅向阳.内镜微创治疗尿道狭窄或闭锁38例临床观察[J].中国现代医生,2010,(6).
[2]李乐山,龙永福,梁木林,王建峰.内镜微创治疗尿道狭窄或闭锁46例[J].南华大学学报(医学版),2009,(4).
[3]宋勇波,马春清,祝存海,方长明,邓辉,叶昶,王进恩,余勇军,高俊.输尿管镜钬激光内切开术治疗尿道狭窄的疗效观察[J].中国现代医生,2010,(4).
[2]李乐山,龙永福,梁木林,王建峰.内镜微创治疗尿道狭窄或闭锁46例[J].南华大学学报(医学版),2009,(4).
[3]宋勇波,马春清,祝存海,方长明,邓辉,叶昶,王进恩,余勇军,高俊.输尿管镜钬激光内切开术治疗尿道狭窄的疗效观察[J].中国现代医生,2010,(4).