联合运用经皮肾筋膜扩张器、输尿管镜及等离子电切镜治疗成年男性尿道狭窄32例
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摘要
目的探讨联合运用经皮肾筋膜扩张器、输尿管镜及等离子电切镜治疗成年男性尿道狭窄的应用技巧及体会。方法中国人民解放军武汉总医院泌尿外科2016年9月至2018年6月收治的32例患者均首先经尿道置入输尿管镜,到达狭窄处后置入斑马导丝,直视下斑马导丝通过尿道狭窄处,然后依次使用8～24F肾筋膜扩张器沿斑马导丝扩张尿道,再用等离子电切镜切除隆起的组织;术后留置18～20 F硅胶导尿管2～4周,出院后定期到门诊行尿道扩张。结果 32例患者手术均取得了预期的疗效,拔管后排尿症状都有不同程度的改善,随访6～12个月,测最大尿流率均>15 m L/s,所有患者都获得了满意的排尿效果。结论联合运用经皮肾筋膜扩张器、输尿管镜及等离子电切镜治疗成年男性尿道狭窄,临床疗效确切,值得推广应用。
Objective To explore the skills and experiences of applying percutaneous renal fascial dilator, ureteroscope and plasma electrotomy in the treatment of adult male urethral stricture. Methods Thirty-two patients in Department of Urology, Wuhan General Hospital of People's Liberation Amy of China from September 2016 to June 2018 first received ureteroscope through urethra. Zebra guide wire was inserted after ureteroscope reaching the stricture and placed through the stricture of urethra under direct vision. Then 8-24 F renal fascia dilator was used to dilate the urethra along the zebra guide wire in turn, and then plasma electrotomy was used to remove the raised tissue. 18-20 F silica gel catheter was retained for 2 to 4 weeks after operation. During the first 3 months after discharge, urethral dilation was regularly performed at out-patient clinic. Results All the 32 patients had achieved desired results. After extubation, the urination symptoms improved in varying degrees. Follow-up for 6-12 months showed that the maximum urinary flow rate was >15 mL/s. All patients achieved satisfactory urination results. Conclusion The combined use of percutaneous renal fascial dilator, ureteroscope and plasma electrotomy in the treatment of adult male urethral stricture has a definite clinical effect and is worthy of popularization and application.
Objective To explore the skills and experiences of applying percutaneous renal fascial dilator, ureteroscope and plasma electrotomy in the treatment of adult male urethral stricture. Methods Thirty-two patients in Department of Urology, Wuhan General Hospital of People's Liberation Amy of China from September 2016 to June 2018 first received ureteroscope through urethra. Zebra guide wire was inserted after ureteroscope reaching the stricture and placed through the stricture of urethra under direct vision. Then 8-24 F renal fascia dilator was used to dilate the urethra along the zebra guide wire in turn, and then plasma electrotomy was used to remove the raised tissue. 18-20 F silica gel catheter was retained for 2 to 4 weeks after operation. During the first 3 months after discharge, urethral dilation was regularly performed at out-patient clinic. Results All the 32 patients had achieved desired results. After extubation, the urination symptoms improved in varying degrees. Follow-up for 6-12 months showed that the maximum urinary flow rate was >15 mL/s. All patients achieved satisfactory urination results. Conclusion The combined use of percutaneous renal fascial dilator, ureteroscope and plasma electrotomy in the treatment of adult male urethral stricture has a definite clinical effect and is worthy of popularization and application.
引文
[1] BHAGER A, NAYAK B, RAI PK, et al. Post TURP obliterative urefhral stricture:unusual presentation and favourable result[J]. Afr J Urol, 2013, 19(2):78-81.
[2]王卫亚,翟景光.输尿管镜联合钬激光治疗男性尿道狭窄临床观察[J].中国社区医师:医学专业, 2012, 14(15):129.
[3] KULKARNI SB, BARBAGLI G, KULKARNI JS, et al. Posterior urethral stricture after pelvic fracture urethral distraction defects in developing and developed countries, and choice of surgical technique[J]. J Urol, 2010, 183(3):1049-1054.
[4]王峰业.内镜辅助下筋膜扩张器治疗男性尿道狭窄[J].现代医用影像学, 2017, 26(6):1554-1555, 1558.
[5] WALSH PC, RETIK AB, VAUGHAN ED, et al. Campbell, s urology[M]. USA:An Imprint of Elsevier Science, 2002:3919-3924.
[6]王君,刘会范,贾占奎,等.直视下尿道内切开术联合尿道扩张治疗男性尿道狭窄36例疗效分析[J].临床泌尿外科杂志, 2013, 28(4):276-277, 281.
[7]吴俊杰,崔子连.经尿道输尿管镜钬激光在治疗尿道狭窄中的应用(附18例报告)[J].泌尿外科杂志(电子版), 2015, 7(1):38-40.
[8]刘黎涛.经尿道前列腺汽化电切术后尿道狭窄的病因及防治分析[J].临床合理用药杂志, 2012, 5(16):137-138.
[9]孙涛,汤春波,杜洲舸,等.斑马导丝引导下Amplatz肾扩张器治疗尿道狭窄[J].中国医师进修杂志, 2010, 33(33):37-38.
[10]杨小杰,何辉,张越,等.输尿管镜联合筋膜扩张器在男性尿道狭窄治疗中的应用(附12例报告)[J].现代泌尿外科杂志, 2008, 13(2):147-148.
[11]张冠,吕冰,孙钺,等.表面浸润麻醉下冷刀切开治疗尿道狭窄(附6例病例报告)[J].中国内镜杂志, 2004, 10(9):4-5.
[12]冉金生,苏书光.尿道狭窄手术方式与术后复发[J].中国医药科学,2014, 4(4):188-189, 205.
[13]赵拴明.输尿管镜、钬激光联合筋膜扩张器治疗男性尿道狭窄的效果[J].中国实用医药, 2017, 12(18):79-80.
[14]杨益民,陈志阳.肾筋膜扩张器联合输尿管细镜、钬激光在尿道狭窄治疗中的临床运用[J].中国医药指南, 2017, 15(26):166-167.
[2]王卫亚,翟景光.输尿管镜联合钬激光治疗男性尿道狭窄临床观察[J].中国社区医师:医学专业, 2012, 14(15):129.
[3] KULKARNI SB, BARBAGLI G, KULKARNI JS, et al. Posterior urethral stricture after pelvic fracture urethral distraction defects in developing and developed countries, and choice of surgical technique[J]. J Urol, 2010, 183(3):1049-1054.
[4]王峰业.内镜辅助下筋膜扩张器治疗男性尿道狭窄[J].现代医用影像学, 2017, 26(6):1554-1555, 1558.
[5] WALSH PC, RETIK AB, VAUGHAN ED, et al. Campbell, s urology[M]. USA:An Imprint of Elsevier Science, 2002:3919-3924.
[6]王君,刘会范,贾占奎,等.直视下尿道内切开术联合尿道扩张治疗男性尿道狭窄36例疗效分析[J].临床泌尿外科杂志, 2013, 28(4):276-277, 281.
[7]吴俊杰,崔子连.经尿道输尿管镜钬激光在治疗尿道狭窄中的应用(附18例报告)[J].泌尿外科杂志(电子版), 2015, 7(1):38-40.
[8]刘黎涛.经尿道前列腺汽化电切术后尿道狭窄的病因及防治分析[J].临床合理用药杂志, 2012, 5(16):137-138.
[9]孙涛,汤春波,杜洲舸,等.斑马导丝引导下Amplatz肾扩张器治疗尿道狭窄[J].中国医师进修杂志, 2010, 33(33):37-38.
[10]杨小杰,何辉,张越,等.输尿管镜联合筋膜扩张器在男性尿道狭窄治疗中的应用(附12例报告)[J].现代泌尿外科杂志, 2008, 13(2):147-148.
[11]张冠,吕冰,孙钺,等.表面浸润麻醉下冷刀切开治疗尿道狭窄(附6例病例报告)[J].中国内镜杂志, 2004, 10(9):4-5.
[12]冉金生,苏书光.尿道狭窄手术方式与术后复发[J].中国医药科学,2014, 4(4):188-189, 205.
[13]赵拴明.输尿管镜、钬激光联合筋膜扩张器治疗男性尿道狭窄的效果[J].中国实用医药, 2017, 12(18):79-80.
[14]杨益民,陈志阳.肾筋膜扩张器联合输尿管细镜、钬激光在尿道狭窄治疗中的临床运用[J].中国医药指南, 2017, 15(26):166-167.