2微米激光治疗女性尿道肉阜的疗效及安全性评价的临床研究
发布时间：2018-07-27 16:10
【摘要】：目的：探讨2微米激光治疗女性尿道肉阜止血的效果和机制，评估2微米激光治疗女性尿道肉阜的疗效及安全性，，探索2微米激光治疗女性尿道肉阜术后无管化的可行性。 方法：前瞻性研究贵州省人民医院2010年1月至2014年1月行2微米激光女性尿道肉阜切除患者20例。回顾性研究贵州省人民医院2005年12月至2013年12月行常规女性尿道肉阜切除患者20例（其中高频电刀切除10例，手术刀切除10例）。经2微米激光及高频电刀切除术后的尿道肉阜组织标本，应用HE染色光镜下观察尿道肉阜切缘组织形态学改变。比较2微米激光尿道肉阜切除术与常规尿道肉阜切除术的手术时间、术中出血量、留置尿管时间、术后住院时间和无管化率。分别采用视觉模拟评分法（VisualAnalogue Scale/Score，VAS)和膀胱过度活动症评分法（Overactivity Bladder Symptom Score，OABSS)对两组患者围手术期疼痛和尿路刺激症状进行评估。比较两组患者在术后有无尿潴留、出血、疼痛、排尿困难、尿道外口狭窄、尿道阴道瘘和复发情况。 结果：（1）与高频电刀尿道肉阜切除术相比，2微米激光术后尿道肉阜组织切缘更平滑，焦痂更小，形成的凝固层更浅；2微米激光和高频电刀均通过组织凝固，血管收缩闭合而起到止血效果，但2微米激光凝固层内血管收缩更明显，管腔内未见红细胞，而高频电刀凝固层内部分血管扩张，管腔内见大量红细胞。 （2）2微米激光组与常规手术组的手术时间分别为5.3±1.03min和14.4±3.14min，两组比较，差异有统计学意义（P＜0.05）；留置尿管时间分别为0.25±0.79d和4.05±1.19d，两组比较，差异有统计学意义（P＜0.05）；术中出血量分别为3.71±1.04ml和11.03±2.59ml，两组比较，差异有统计学意义（P＜0.05）；术后住院时间分别为2.2±0.52d和4.5±1.0d，两组比较，差异有统计学意义（P＜0.05）。2微米激光组术后仅有2例留置尿管，无管化率为90%（18/20），而常规手术组术后均留置尿管，无管化率为0（0/20），两组比较，差异有统计学意义（P＜0.05）。 （3）2微米激光组与较常规手术组术前VAS评分分别为1.45±1.28（0～4）和1.55±1.64（0～4），两组比较，差异无统计学意义（P=0.804）；两组术毕VAS评分分别为1.60±0.88（0～3）和3.80±0.83（2～5），两组比较，差异有统计学意义（P＜0.05）；两组术后24小时VAS评分分别为0.95±0.99（0～3）和3.05±0.89（2～4），两组比较，差异有统计学意义（P＜0.05）。2微米激光组与常规手术组术前OABSS总评分分别为0.50±0.83（0～2）和1.00±1.17（0～3），两组比较，差异无统计学意义（P=0.188）；两组术后24小时OABSS总评分分别为0.7±1.3（0～3）和4.25±0.91（3～6），两组比较，差异有统计学意义（P＜0.05）；两组术后2天OABSS总评分分别为0.35±0.88（0～3）和3.7±0.86（3～5），两组比较，差异有统计学意义（P＜0.05）；两组术后3天OABSS总评分分别为0.00±0.00（0～0）和2.7±1.08（0～5），两组比较，差异有统计学意义（P＜0.05）。 （4）2微米激光组无术后出血，常规手术组有5例术后出血；2微米激光组有2例术后初期排尿疼痛，常规手术组有3例术后初期排尿疼痛；2微米激光组无排尿困难，常规手术组有1例出现排尿困难。2微米激光组20例患者均一次治疗后达到痊愈标准；常规手术组有1例10个月后肉阜复发，进行了二次手术。 结论：（1）2微米激光治疗女性尿道肉阜的止血机制是激光导致组织血管凝固收缩； （2）与常规尿道肉阜切除术相比，2微米激光尿道肉阜切除术疗效更好，安全性可靠； （3）2微米激光治疗女性尿道肉阜术后无管化是可行的。
[Abstract]:Objective: To explore the effect and mechanism of 2 micron laser treatment for female urethral caruncle hemostasis, evaluate the efficacy and safety of 2 micron laser in the treatment of female urethral caruncle, and explore the feasibility of 2 micron laser for the treatment of female urethral caruncle.
Methods: 20 cases of 2 micron laser female urethral caruncle resection in Guizhou People's Hospital from January 2010 to January 2014 were prospectively studied. 20 cases of normal female urethral caruncle resection from December 2005 to December 2013 were retrospectively studied (of which 10 cases were cut by high frequency electric knife and 10 cases with surgical knife resection). 2 micron laser was used. The tissue morphology of urethra caruncle after the resection of high frequency electroknife was used to observe the histomorphological changes of the caruncle edge of the urethra by HE staining. The operative time of 2 micron laser urethral caruncle resection and conventional urethral caruncle resection, intraoperative bleeding, indwelling catheter time, postoperative hospitalization time and non tube rate were compared. VisualAnalogue Scale/Score (VAS) and urinary bladder hyperactivity syndrome (Overactivity Bladder Symptom Score, OABSS) were used to evaluate the perioperative pain and urinary tract irritation symptoms in two groups. Compared to the two groups, there were no urinary retention, bleeding, pain, dysuria, urethral stricture, urethral vaginal fistula and recovery after operation. Situation.
Results: (1) compared with the high frequency electroknife urethral caruncle resection, the cutting edge of caruncle tissues of the urethra was smoother after 2 micron laser surgery, the eschar was smaller and the solidified layer formed more shallow; the 2 micron laser and high frequency electric knife all solidified by tissue, and the vasoconstriction closed to the hemostatic effect, but the blood vessel contraction in the 2 micron laser solidified layer was more obvious in the lumen and the lumen inside the lumen No red blood cells were found, while some of the vessels in the coagulation layer of the high frequency electrocautery were dilated and a large number of red blood cells were seen in the lumen.
(2) the operation time of the 2 micron laser group and the conventional operation group was 5.3 + 1.03min and 14.4 + 3.14min respectively. The difference between the two groups was statistically significant (P < 0.05); the indwelling catheter time was 0.25 + 0.79d and 4.05 + 1.19d respectively. The difference between the two groups was statistically significant (P < 0.05), and the intraoperative bleeding volume was 3.71 + 1.04ml and 11.03 + 2.59ml, two, two. The difference was statistically significant (P < 0.05); the postoperative hospitalization time was 2.2 0.52d and 4.5 1.0d respectively. The two groups were statistically significant (P < 0.05) there were only 2 indwelling urethral catheters in.2 micron laser group and 90% (18/20) without catheterization in the routine operation group, and the rate of catheterization was 0 (0/20) after operation in the routine operation group. The difference between the two groups was different. The difference was the difference between the two groups. There were statistical significance (P < 0.05).
(3) the preoperative VAS score of the 2 micron laser group was 1.45 + 1.28 (0~4) and 1.55 + 1.64 (0~4), respectively. There was no significant difference in the two groups (P=0.804). The two group VAS scores were 1.60 + 0.88 (0~3) and 3.80 +. The difference was statistically significant (P The difference was 0.95 + 0.99 (0~3) and 3.05 + 0.89 (2~4) respectively. The difference was statistically significant (P < 0.05) and the total OABSS score of.2 micron laser group and routine operation group was 0.50 + 0.83 (0~2) and 1 + 1.17 (0~3), and the difference was not statistically significant (P=0.188). To 3 and 4.25 + 0.91 (3~6), the difference between the two groups was statistically significant (P < 0.05), and the total OABSS score of the two groups was 0.35 + 0.88 (0~3) and 3.7 + 0.86 (3~5), respectively, and the difference was statistically significant (P There were statistical significance (P < 0.05).
(4) there were no postoperative bleeding in the 2 micron laser group and 5 cases of postoperative bleeding in the routine operation group; 2 cases of postoperative urination pain in the 2 micron laser group, 3 cases of early posturination pain in the routine operation group, no dysuria in the 2 micron laser group, and 1 cases of.2 micron laser in the routine operation group, 20 patients were recovered after a uniform treatment. There were 1 cases in the routine operation group who relapsed after 10 months, and two operations were performed.
Conclusion: (1) the mechanism of 2 micron laser treatment of female urethra caruncle is the coagulation and contraction of blood vessels caused by laser.
(2) compared with routine urethral caruncle resection, 2 micron laser urethral caruncle resection is better and safe.
(3) it is feasible to treat the female urethra caruncle with 2 micron laser.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.7
本文编号：2148374
[Abstract]:Objective: To explore the effect and mechanism of 2 micron laser treatment for female urethral caruncle hemostasis, evaluate the efficacy and safety of 2 micron laser in the treatment of female urethral caruncle, and explore the feasibility of 2 micron laser for the treatment of female urethral caruncle.
Methods: 20 cases of 2 micron laser female urethral caruncle resection in Guizhou People's Hospital from January 2010 to January 2014 were prospectively studied. 20 cases of normal female urethral caruncle resection from December 2005 to December 2013 were retrospectively studied (of which 10 cases were cut by high frequency electric knife and 10 cases with surgical knife resection). 2 micron laser was used. The tissue morphology of urethra caruncle after the resection of high frequency electroknife was used to observe the histomorphological changes of the caruncle edge of the urethra by HE staining. The operative time of 2 micron laser urethral caruncle resection and conventional urethral caruncle resection, intraoperative bleeding, indwelling catheter time, postoperative hospitalization time and non tube rate were compared. VisualAnalogue Scale/Score (VAS) and urinary bladder hyperactivity syndrome (Overactivity Bladder Symptom Score, OABSS) were used to evaluate the perioperative pain and urinary tract irritation symptoms in two groups. Compared to the two groups, there were no urinary retention, bleeding, pain, dysuria, urethral stricture, urethral vaginal fistula and recovery after operation. Situation.
Results: (1) compared with the high frequency electroknife urethral caruncle resection, the cutting edge of caruncle tissues of the urethra was smoother after 2 micron laser surgery, the eschar was smaller and the solidified layer formed more shallow; the 2 micron laser and high frequency electric knife all solidified by tissue, and the vasoconstriction closed to the hemostatic effect, but the blood vessel contraction in the 2 micron laser solidified layer was more obvious in the lumen and the lumen inside the lumen No red blood cells were found, while some of the vessels in the coagulation layer of the high frequency electrocautery were dilated and a large number of red blood cells were seen in the lumen.
(2) the operation time of the 2 micron laser group and the conventional operation group was 5.3 + 1.03min and 14.4 + 3.14min respectively. The difference between the two groups was statistically significant (P < 0.05); the indwelling catheter time was 0.25 + 0.79d and 4.05 + 1.19d respectively. The difference between the two groups was statistically significant (P < 0.05), and the intraoperative bleeding volume was 3.71 + 1.04ml and 11.03 + 2.59ml, two, two. The difference was statistically significant (P < 0.05); the postoperative hospitalization time was 2.2 0.52d and 4.5 1.0d respectively. The two groups were statistically significant (P < 0.05) there were only 2 indwelling urethral catheters in.2 micron laser group and 90% (18/20) without catheterization in the routine operation group, and the rate of catheterization was 0 (0/20) after operation in the routine operation group. The difference between the two groups was different. The difference was the difference between the two groups. There were statistical significance (P < 0.05).
(3) the preoperative VAS score of the 2 micron laser group was 1.45 + 1.28 (0~4) and 1.55 + 1.64 (0~4), respectively. There was no significant difference in the two groups (P=0.804). The two group VAS scores were 1.60 + 0.88 (0~3) and 3.80 +. The difference was statistically significant (P The difference was 0.95 + 0.99 (0~3) and 3.05 + 0.89 (2~4) respectively. The difference was statistically significant (P < 0.05) and the total OABSS score of.2 micron laser group and routine operation group was 0.50 + 0.83 (0~2) and 1 + 1.17 (0~3), and the difference was not statistically significant (P=0.188). To 3 and 4.25 + 0.91 (3~6), the difference between the two groups was statistically significant (P < 0.05), and the total OABSS score of the two groups was 0.35 + 0.88 (0~3) and 3.7 + 0.86 (3~5), respectively, and the difference was statistically significant (P There were statistical significance (P < 0.05).
(4) there were no postoperative bleeding in the 2 micron laser group and 5 cases of postoperative bleeding in the routine operation group; 2 cases of postoperative urination pain in the 2 micron laser group, 3 cases of early posturination pain in the routine operation group, no dysuria in the 2 micron laser group, and 1 cases of.2 micron laser in the routine operation group, 20 patients were recovered after a uniform treatment. There were 1 cases in the routine operation group who relapsed after 10 months, and two operations were performed.
Conclusion: (1) the mechanism of 2 micron laser treatment of female urethra caruncle is the coagulation and contraction of blood vessels caused by laser.
(2) compared with routine urethral caruncle resection, 2 micron laser urethral caruncle resection is better and safe.
(3) it is feasible to treat the female urethra caruncle with 2 micron laser.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.7
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