2μm外科激光联合泼尼松治疗男性尿道狭窄的安全性及疗效分析
发布时间：2019-01-09 07:58
【摘要】：背景及目的:男性泌尿系统疾病中尿道狭窄是一种比较棘手的泌尿外科疾病,临床症状与前列腺增生等下尿路梗阻性疾病临床表现类似,治疗方法不统一,效果欠佳。目前关于尿道狭窄的治疗方法多样化,大致分为开放手术及经尿道腔内微创手术两大类。传统开放类手术虽然治疗尿道狭窄的疗效确切无异议,但因其具有开放类手术的共同缺点,即开放手术致伤口创面较大,并发症比较多,现在已很少采用。随着微创技术的发展,腔内微创手术治疗尿道狭窄已经成为大家公认的首选治疗方法。腔内切开微创手术治疗尿道狭窄的技术包括激光类、电切、冷刀、等离子等等。各类切开技术各有优缺点,冷刀及等离子技术止血效果差,致术中出血较多、视野不清晰,腔内电切技术精准度差,很容易引起术后二次尿道狭窄;现在上述三项技术因其弊端较多,在治疗尿道狭窄手术中已不常用。激光类治疗尿道狭窄因其精准、止血及疗效好,现在已成为医学界治疗尿道狭窄的手术首选方式。研究证实2μm激光治疗尿道狭窄疗效明确,本试验通过对入组患者一般资料进行分析研究,比较手术前后最大尿流率值的差异,分析2μm(铥)激光手术治疗尿道狭窄的安全性,同时随访研究患者手术后联合口服泼尼松药物治疗尿道狭窄的临床疗效,获得满意的成效,为男性尿道狭窄的临床治疗提供新的思路和具体实施方法,对于今后尿道狭窄临床工作的进行具有指导意义。方法:选取我院近三年来收集的62例男性尿道狭窄患者的一般资料进行对比分析研究,所有入组患者术前常规检测最大尿流率(Qmax)、尿道造影,择期行2μm激光尿道狭窄切开手术,术后留置F20#~22#三腔大气囊尿管,嘱试验组与对照组患者尿管保留约2月,患者依从性良好,两组术后每月复查最大尿流率,连续复查3个月。试验组术后1周开始行泼尼松口服治疗,低剂量5mg/天,连续口服2月,拔除尿管后药物减量至1/3片,继续维持一周左右,后逐渐停药,对照组不予泼尼松治疗。结果:1、62例患者均行2μm激光腔内切开手术,手术均成功完成,术前、术中无并发症发生。2、所有患者术后Qmax与术前比较有显著统计学差异(P0.01);试验组与对照组术后患者的排尿时间均比术前有统计学差异(P0.05);术后3月、4月、5月试验组与对照组Qmax值比较,有统计学差异(P0.05)。3、观察患者术后排尿症状的改善程度、手术是否成功的指标不是最大尿流率的数值大小,而是最大尿流率术前术后的差值改变。4、试验组、对照组拔出尿管后,术后随访半年,全部排尿通畅,试验组拔出尿管的时间与对照组比较无明显统计学差异,尚不能认为保留尿管时间越长越好。5、试验组术后有2例患者术后出现睾丸炎,有1例试验组患者术后时间32天时尿管自行拔出,后重新置入尿管,其余患者(包括对照组患者)均无尿失禁,睾丸炎、附睾炎及勃起障碍等并发症发生;术后随访过程中,试验组患者服用泼尼松期间均未引起感染、糖尿病、类cushing综合征症状等副作用。结论:2μm激光手术联合泼尼松药物治疗尿道狭窄的安全性及疗效性好,值得临床推广;最大尿流率(Qmax)数值在诊断尿道狭窄及术后疗效随访中具有高灵敏性,建议诊疗尿道狭窄首选;对于尿道狭窄患者尿管保留时间,是不是时间越长越好,有待进一步研究。
[Abstract]:BACKGROUND & OBJECTIVE: The urethral stricture in male urinary system is a more difficult urological disease. The clinical symptoms are similar to that of the lower urinary tract obstructive diseases such as the prostatic hyperplasia. The treatment method is not uniform and the effect is not good. At present, the method of treatment for urethral stricture is divided into two categories: open surgery and minimally invasive surgery in the transurethral cavity. The traditional open-type operation has no objection to the treatment of urethral stricture, but it has the common drawback of open surgery, that is, the wound surface is large with the open operation, and the complication is much, and it is now very rarely used. With the development of minimally invasive technique, minimally invasive surgery in the cavity for the treatment of urethral stricture has become a generally accepted method of treatment. The technique of minimally invasive surgery for the treatment of urethral stricture includes laser, electric cutting, cold knife, plasma and so on. the various cutting techniques have advantages and disadvantages, the advantages and disadvantages of the cold knife and the plasma technology are poor, the bleeding is more in the operation, the visual field is not clear, the precision of the electric cutting technique in the cavity is poor, the postoperative secondary urethral stricture can be easily caused, It is not commonly used in the treatment of urethral stricture. Laser-based treatment of urethral stricture has become the first choice for the treatment of urethral stricture due to its precise, hemostatic and therapeutic effects. The efficacy of 2. m laser in the treatment of urethral stricture was confirmed. The general data of the patients in the group were analyzed and compared, the difference of the maximum urinary flow rate before and after operation was compared, and the safety of the urethral stricture was analyzed by 2. m At the same time, the clinical effect of combined oral prednisone for the treatment of urethral stricture after the operation of the patients was followed up, and the satisfactory results were obtained. Methods: The general data of 62 cases of male urethral stricture collected in the last three years of our hospital were compared and analyzed. After the operation, the urine tube of the large air bag of the F20 # ~ 22 # 3-chamber was retained. The test group and the control group were instructed to keep the urine tube for about 2 months. The patient's compliance was good. The maximum urine flow rate was re-examined every month after the two groups, and it was continuously reviewed for 3 months. Prednisone oral treatment was started at 1 week after the operation of the test group. The low dose of 5mg/ day was used for continuous oral administration. The drug was reduced to 1/ 3 tablets after the removal of the urine tube, and the treatment was continued for a week or so, and the control group was not treated with prednisone. Results: 1, 62 patients had a 2. m laser cavity incision, and the operation was completed successfully. There was no complication in the operation before operation. The postoperative Qmax of all patients was significantly different from that before operation (P0.01). There was a significant difference between the test group and the control group after operation (P <0.05). There was a significant difference between the test group and the control group (P0.05). The success rate of the operation was not the value of the maximum urinary flow rate, but the difference between the maximum urinary flow rate and the post-operation was changed. There was no significant difference in the time between the test group and the control group, and it was not considered that the longer the time of the retention of the urine tube was. 5. There were 2 cases of orchitis after the operation of the trial group. The urine tube was pulled out by the urine tube at the time of 32 days after the operation of the test group, and then the urine tube was put into the urine tube. The remaining patients (including the control group) had no complications such as urinary incontinence, orchitis, epididymitis and erectile dysfunction. During the follow-up, the patients in the trial group did not cause side effects such as infection, diabetes, and the symptom of cushing's syndrome. Conclusion: The safety and curative effect of 2. m laser combined with prednisone in the treatment of urethral stricture is good, and it is worthy of clinical promotion. The value of the maximum urinary flow rate (Qmax) has high sensitivity in the diagnosis of urethral stricture and postoperative follow-up. It is suggested that the diagnosis and treatment of urethral stricture is the first choice; For urethral stricture, the longer the urine tube retention time, the longer the time is, the better it is to be further studied.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R695
本文编号：2405344
[Abstract]:BACKGROUND & OBJECTIVE: The urethral stricture in male urinary system is a more difficult urological disease. The clinical symptoms are similar to that of the lower urinary tract obstructive diseases such as the prostatic hyperplasia. The treatment method is not uniform and the effect is not good. At present, the method of treatment for urethral stricture is divided into two categories: open surgery and minimally invasive surgery in the transurethral cavity. The traditional open-type operation has no objection to the treatment of urethral stricture, but it has the common drawback of open surgery, that is, the wound surface is large with the open operation, and the complication is much, and it is now very rarely used. With the development of minimally invasive technique, minimally invasive surgery in the cavity for the treatment of urethral stricture has become a generally accepted method of treatment. The technique of minimally invasive surgery for the treatment of urethral stricture includes laser, electric cutting, cold knife, plasma and so on. the various cutting techniques have advantages and disadvantages, the advantages and disadvantages of the cold knife and the plasma technology are poor, the bleeding is more in the operation, the visual field is not clear, the precision of the electric cutting technique in the cavity is poor, the postoperative secondary urethral stricture can be easily caused, It is not commonly used in the treatment of urethral stricture. Laser-based treatment of urethral stricture has become the first choice for the treatment of urethral stricture due to its precise, hemostatic and therapeutic effects. The efficacy of 2. m laser in the treatment of urethral stricture was confirmed. The general data of the patients in the group were analyzed and compared, the difference of the maximum urinary flow rate before and after operation was compared, and the safety of the urethral stricture was analyzed by 2. m At the same time, the clinical effect of combined oral prednisone for the treatment of urethral stricture after the operation of the patients was followed up, and the satisfactory results were obtained. Methods: The general data of 62 cases of male urethral stricture collected in the last three years of our hospital were compared and analyzed. After the operation, the urine tube of the large air bag of the F20 # ~ 22 # 3-chamber was retained. The test group and the control group were instructed to keep the urine tube for about 2 months. The patient's compliance was good. The maximum urine flow rate was re-examined every month after the two groups, and it was continuously reviewed for 3 months. Prednisone oral treatment was started at 1 week after the operation of the test group. The low dose of 5mg/ day was used for continuous oral administration. The drug was reduced to 1/ 3 tablets after the removal of the urine tube, and the treatment was continued for a week or so, and the control group was not treated with prednisone. Results: 1, 62 patients had a 2. m laser cavity incision, and the operation was completed successfully. There was no complication in the operation before operation. The postoperative Qmax of all patients was significantly different from that before operation (P0.01). There was a significant difference between the test group and the control group after operation (P <0.05). There was a significant difference between the test group and the control group (P0.05). The success rate of the operation was not the value of the maximum urinary flow rate, but the difference between the maximum urinary flow rate and the post-operation was changed. There was no significant difference in the time between the test group and the control group, and it was not considered that the longer the time of the retention of the urine tube was. 5. There were 2 cases of orchitis after the operation of the trial group. The urine tube was pulled out by the urine tube at the time of 32 days after the operation of the test group, and then the urine tube was put into the urine tube. The remaining patients (including the control group) had no complications such as urinary incontinence, orchitis, epididymitis and erectile dysfunction. During the follow-up, the patients in the trial group did not cause side effects such as infection, diabetes, and the symptom of cushing's syndrome. Conclusion: The safety and curative effect of 2. m laser combined with prednisone in the treatment of urethral stricture is good, and it is worthy of clinical promotion. The value of the maximum urinary flow rate (Qmax) has high sensitivity in the diagnosis of urethral stricture and postoperative follow-up. It is suggested that the diagnosis and treatment of urethral stricture is the first choice; For urethral stricture, the longer the urine tube retention time, the longer the time is, the better it is to be further studied.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R695
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