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目的评价输尿管镜辅助下双极等离子体电切治疗尿道狭窄的疗效和安全性。方法 2004年1月至2008年12月,运用27 F GYRUS双极等离子体电切镜在8~9.8 F WOLF输尿管镜辅助下治疗41例男性尿道狭窄患者,年龄18～69岁,平均28岁。其中外伤性尿道狭窄27例,炎症性狭窄3例,前列腺术后狭窄8例,成人尿道下裂术后狭窄3例。所有患者经尿道造影及尿流率检查。狭窄段长度0.3～3.0 cm,平均1.23 cm。其中狭窄段内径>3 F者28例(A组);狭窄段内径<3 F,且部分病例为尿道闭锁、假道者13例(B组)。术后随访12～18个月。结果全组手术成功率78%(32/41),其中A组28例中23例(前尿道11例,后尿道10例,球膜连接部2例)手术1次成功,成功率82.1%(23/28);出现并发症5例(再狭窄3例,并发尿道穿孔、尿外渗各1例),并发症发生率17.9%(5/28);尿道穿孔、尿外渗2例患者经留置导尿管后自行愈合,3例再狭窄患者行开放性手术。B组13例中成功9例(前尿道3例,后尿道5例,球膜部1例),成功率69.2%(9/13);失败4例(1例因狭窄超过3.0 cm术后再发狭窄,1例合并假道,2例因尿道连续性完全破坏),并发症发生率30.8%(4/13),失败原因均为术中无法标记真道。B组4例内镜失败患者同样行开放性手术治疗。结论双极等离子体电切可以有效去除尿道瘢痕组织,在输尿管镜辅助下提高了治愈成功率,适宜于可以标引真道、且狭窄段长度不超过2.0 cm者,效果较好,为内镜治疗尿道狭窄的选项之一。
Objective To evaluate the efficacy and safety of ureteroscopic assisted bipolar plasma electrosurgical excision for urethral stricture. Methods From January 2004 to December 2008, 41 male urethral strictures were treated with 8 ~ 9.8 F WOLF ureteroscope assisted by 27 F GYRUS bipolar plasma electron micrograph. The mean age was from 18 to 69 years with an average of 28 years. Including traumatic urethral stricture in 27 cases, 3 cases of inflammatory stenosis, prostate stenosis in 8 cases, 3 cases of adult hypospadias stenosis. All patients underwent transurethral angiography and urine flow rate examination. The length of the stenosis ranged from 0.3 to 3.0 cm with an average of 1.23 cm. Among them, 28 cases had a diameter of> 3 F in the narrow segment (group A); the diameter of the stenosis was <3 F, and in some cases urethral atresia and 13 cases of the prosthesis (group B). The patients were followed up for 12 to 18 months. Results The success rate of the operation was 78% (32/41) in all the cases. Of the 28 cases in group A, 23 cases (11 in the anterior urethra, 10 in the posterior urethra, 2 in the posterior urethra) were successful in one operation with a success rate of 82.1% There were 5 complications (3 cases of restenosis, 1 case of urethral perforation and 1 case of extravasation), and the complication rate was 17.9% (5/28). There were 2 cases of urethral perforation and urine extravasation After indwelling catheter self-healing, 3 patients with restenosis underwent open surgery. In group B, 9 cases were successful in 9 cases (3 cases of anterior urethra, 5 cases of posterior urethra and 1 case of sphenoid membrane) with a success rate of 69.2% (9/13); 4 cases failed (1 case had stenosis over 3.0 cm 1 case complicated with false passage and 2 cases completely destroyed by urethral continuity). The complication rate was 30.8% (4/13). The reasons for the failure were that the pathology could not be labeled intraoperatively. In group B, 4 patients with endoscopic failure also underwent open surgery. Conclusions Bipolar plasma electrosurgical excision can effectively remove the scar tissue of the urethra and improve the success rate of cure with the help of ureteroscopy. It is suitable for the indexing of authentic pathways and the stenosis length is less than 2.0 cm. One of the options for urethral stricture.