钬激光与冷刀内切开治疗男性单纯性尿道狭窄疗效比较

发布时间：2018-04-29 19:56

本文选题：输尿管镜 + 钬激光　；参考：《山西医科大学》2014年硕士论文

【摘要】：[目的] 通过输尿管镜钬激光与冷刀内切开术治疗男性单纯性尿道狭窄的比较来评价两种术式的临床疗效。 [方法] 回顾性分析自2008年1月至2013年2月在山西省运城市中心医院行微创手术治疗的68例男性单纯性尿道狭窄患者,其中行输尿管镜下钬激光治疗37例(A组),行冷刀内切开治疗31例(B组)。收集和记录两组患者术前、术中及术后的相关临床指标,包括一般资料(年龄、部位、长度、术前最大尿流率)、手术时间、术中出血量、术中并发症、术后最大尿流率(Qmax)、术后尿道扩张次数、复发例数、再手术例数、术后并发症,并进行统计学分析,比较两组的临床疗效。 [结果] 1.A组(钬激光组)和B组(冷刀组)治疗男性单纯性尿道狭窄的手术时间分别为38.1±8.7min、20.3±5.5min；A组(钬激光组)和B组(冷刀组)术中出血量分别为19.8±5.8m1、31.3±8.5m1。两组间比较差异有统计学意义(P0.05)。 2.术后A组获随访患者34例,随访时间4-30个月,平均14月,术后平均扩尿道次数11.1±3.1次,术后平均最大尿流率19.2±3.4ml/s,复发6例(17.6%),再次手术者3例(8.8%)；B组获随访患者28例,随访时间6～35个月,平均16月,术后平均扩尿道次数16.1±4.9次,术后平均最大尿流率15.1±2.9ml/s,复发9例(32.1%),再次手术者6例(24.1%)。两组间在术后最大尿流率、术后扩尿道次数、复发率、再手术率方面比较差异有统计学意义(P0.05)。 3.A组术中无尿外渗病例发生,术后无尿失禁病例出现；B组术中有2例尿外渗病例,术后有1例尿失禁病例发生。 [结论] 输尿管镜钬激光治疗男性单纯性尿道狭窄安全有效,可重复,手术出血少,大大降低了复发率和再手术率,比经尿道冷刀内切开治疗效果好,但手术时间较长。
[Abstract]:[purpose] To evaluate the clinical efficacy of ureteroscopic holmium laser and cold knife endotomy in the treatment of male simple urethral stricture. [methods] From January 2008 to February 2013, 68 male patients with simple urethral stricture underwent minimally invasive surgery in Yuncheng Central Hospital of Shanxi Province. Among them, 37 cases of group A were treated with holmium laser under ureteroscope, and 31 cases of group B were treated with cold knife incision. To collect and record the clinical data of the patients before, during and after operation, including general data (age, location, length, preoperative maximum urinary flow rate, operative time, intraoperative bleeding volume, intraoperative complications). The maximum postoperative urinary flow rate (Qmax), the number of urethral dilatation, recurrence, reoperation and postoperative complications were analyzed statistically, and the clinical effects of the two groups were compared. [results] 1. The operative time of simple urethral stricture in group A (holmium laser group) and group B (cold knife group) was 38.1 卤8.7 min and 20.3 卤5.5 min respectively. The intraoperative bleeding in group A (holmium laser group) and group B (cold knife group) were 19.8 卤5.8m1m-1 and 31.3 卤8.5m1respectively. The difference between the two groups was statistically significant (P 0.05). 2. In group A, 34 patients were followed up for 4-30 months (mean 14 months), the average number of urethral dilatation was 11.1 卤3.1, the average maximum flow rate was 19.2 卤3.4 ml / s, and the recurrence rate was 17.6%. In group B, 28 cases were followed up, and the follow-up time ranged from 6 months to 35 months. The average number of urethral dilatation was 16.1 卤4.9, the mean maximum flow rate was 15.1 卤2.9 ml / s, the recurrence was 32.1ml / s, and the second operation was 24.1ml / s. There were significant differences between the two groups in terms of the maximum urinary flow rate, the number of urethral dilatation, the recurrence rate and the reoperation rate (P 0.05). 3. In group A, there were no cases of exosmosis during operation, two cases of exosmosis in group B and one case of urinary incontinence after operation. [conclusion] Ureteroscopic holmium: YAG laser in the treatment of male simple urethral stricture is safe, effective, repeatable, and less bleeding. It greatly reduces the recurrence rate and reoperation rate, which is better than that of transurethral cold knife incision, but the operation time is longer.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.6

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