等离子体柱状电极联合环状电极腔内治疗男性后尿道狭窄

摘要

目的 评价经尿道等离子体柱状电极联合环状电极腔内治疗后尿道狭窄的临床疗效. 方法 2007年9月～2012年9月,采用英国Gyrus公司等离子体柱状电极联合环状电极,腔内治疗24例男性后尿道狭窄.术前狭窄长度9.2～24.3 mm,平均13.6 mm.术前与术后l、3个月行常规尿道造影及最大尿流率测定,术后12个月行尿道镜检查,评价手术效果. 结果 术后随访l ～21个月,平均13.6月,其中17例＞12个月.术前最大尿流率4.2～9.1 ml/s,中位数5.6 ml/s,术后最大尿流率16.2 ～ 24.5 ml/s,中位数17.6 ml/s.19例(79.2％)获得成功,无明显尿道梗阻症状,尿道造影或尿道镜检查未发现再狭窄.5例再狭窄,其中1例行开放性尿道成形术,4例定期行尿道扩张. 结论 经尿道等离子体柱状电极联合环状电极治疗后尿道狭窄,手术操作简单,损伤小,瘢痕组织切除效率高,视野清楚,无严重手术并发症,复发率低,是治疗男性后尿道狭窄的安全有效方法.%Objective To evaluate the outcome of using bipolar plasmakinetic instruments in the endoscopic treatment of posterior urethral stricture.Methods 24 male patients with posterior urethral stricture were treated by bipolar Gyrus plasmakinetic instruments between September 2007 and September 2012.The average length of the strictures was 13.6 mm (range:9.2-24.3 mm).All patients underwent urethrography and maximum uroflowmetry examination preoperatively,and 1 month and 3 months after surgery.Urethroscopy was routinely performed at the end of the first year for operation evaluation.Results The average follow-up was 13.6 months (range:1-21months),with 17 cases being followed up for more than 12 months.Preoperative median maximum flow rate (Qmax) was 5.6 ml/s for poterior urethral stricture(range:4.2-9.1 ml/s) and postoperative median Qmax was 17.6 ml/s (range:16.2-24.5 ml/s).19 of the patients had no signs or symptoms to suggest recurrence after urethrograph and urethrography,with a success rate of 79.2％ (19/24).Recurrent stricture was found in 5 cases,and 4 cases needed intermittent urethral dilatation,while 1 case needed open urethroplasty.Conclusions Endoscopic operation with bipolar plasmakinetic is a safe and reliable procedure for poterior urethral stricture resection,with less recurrence and minimal postoperative complications.