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目的探讨输尿管镜、钬激光联合筋膜扩张器在治疗男性尿道狭窄中的应用技巧及体会。方法 58例男性尿道狭窄患者,采用输尿管镜、钬激光联合筋膜扩张器治疗,观察其效果。结果所选58例患者,其手术均已完成,且达到一期切除效果,患者尿管留置时间4~8周,当其尿管拔除后,即进行尿道扩张操作,频率是1次/周,时长根据患者病情确定,6个月~1年不等,且患者排尿均达到通畅标准,尿线粗,最大尿流率>15 ml/s。1例合并膀胱结石术后复查膀胱彩超无结石残留。1例合并膀胱肿瘤术后膀胱规律灌注吡柔比星针1年,术后1年复查无肿瘤复发,但尿流率变小为6 ml/s,行膀胱镜提示尿道再次瘢痕狭窄,经规律尿道扩张6个月后尿流率为16 ml/s。所有病例无术中大出血,直肠损伤,阴茎海绵体损伤,术后随访3个月~4年无尿瘘,无尿失禁并发症。再次并发尿道狭窄3例,其中1例经规律尿道扩张6个月后治愈,另2例二次行输尿管镜下钬激光内切开术。结论输尿管镜、钬激光联合筋膜扩张器治疗男性尿道狭窄技术可行,安全有效,操作简便,值得临床推广应用。
Objective To investigate the application skills and experience of ureteroscope and holmium laser combined with fascia dilator in the treatment of male urethral stricture. Methods 58 cases of male patients with urethral stricture were treated with ureteroscope and holmium laser combined with fascia dilator and the effect was observed. Results The selected 58 patients, the operation has been completed, and achieved a resection effect, the patient catheter indwelling time of 4 to 8 weeks, when the removal of the catheter, the urethral dilatation operation, the frequency is 1 time / week, Duration determined according to the patient’s condition, ranging from 6 months to 1 year, and patients have reached patency standard urination, thick urine, the maximum flow rate of> 15 ml / s. 1 case of bladder stones after recollectoscopy without residual stones. 1 case of bladder tumor combined with regular intravesical instillation of pirarubicin after 1 year of postoperative bladder tumor recurrence without recurrence, but the rate of urinary flow was reduced to 6 ml / s, cystoscopy prompted urethral scar re-scar, by law After 6 months of urethral dilation, the flow rate was 16 ml / s. All cases without intraoperative bleeding, rectal injury, penile cavernous injury, followed up for 3 months to 4 years without urinary fistula, no incontinence complications. Again complicated with urethral stricture in 3 cases, of which 1 case of urethral dilatation by 6 months after cure, the other 2 cases underwent double ureteroscopic holmium laser endotomy. Conclusions Ureteroscopy and holmium laser combined with fascia dilator are feasible, safe and effective for the treatment of male urethral stricture, which is easy to operate and worthy of clinical application.