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目的:探讨经尿道2μm激光尿道内切开术治疗外伤性尿道狭窄与闭锁的治疗效果。方法:50例外伤性后尿道断裂行耻骨上膀胱造瘘术和尿道会师术后再次尿道狭窄或闭锁患者,均经术前积极准备后采用2μm激光直视下尿道内切开术治疗,最大尿流率(MFR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)作为评价手术效果的3个指标,分别于术前、术后拔除尿管、出院3个月后复查所测得。并行统计学分析。结果:50例患者经积极术前准备后均采用2μm激光直视下尿道内切开术治疗,术中均无直肠损伤、尿瘘形成、大出血等,术后留置尿管2~4周,拔除尿管后,最大尿流率从术前的(2.7±0.8)ml/s改善为(15.7±2.1)ml/s,3个月后复查平均最大尿流率为(16.1±2.1)ml/s,IPSS评分从术前的(28.7±5.1)分改善为术后拔除尿管时的(10.2±5.4)分,术后3个月时的(8.8±5.4)分,QOL从术前的(5.7±0.5)分改善为术后拔管时的(2.1±1.7)和术后3个月时的(1.8±1.7)分,47例患者拔除尿管后尿道狭窄没有复发,3例患者复发尿道狭窄,其中1例术后拔除尿管1周出现尿失禁,50例患者拨除尿管后均按原则定期扩尿道,必要时膀胱镜下扩尿道治疗,配合排尿锻炼后全部改善。结论:经尿道2μm激光尿道内切开术是治疗外伤性尿道狭窄或闭锁的一种适宜的好方法。
Objective: To investigate the effect of transurethral 2 μm laser urethrotomy in the treatment of traumatic urethral stricture and atresia. Methods: Fifty patients with traumatic posterior urethral rupture undergoing suprapubic cystostomy and urethral recurrent urethral stricture or atresia were treated with 2μm laser under direct urethral endotracheal incision after active preparation. The maximum urinary incontinence MFR, IPSS and QOL were used as the three indicators to evaluate the operative effect, which were measured preoperatively and postoperatively respectively. The catheter was removed 3 months after discharge. Parallel statistical analysis. Results: 50 patients were treated with 2μm laser under direct urethrotomy underwent positive preoperative preparation. No rectal injury, fistula formation and hemorrhage occurred during the operation. The catheter was removed after 2 ~ 4 weeks and the urine was removed After operation, the maximum flow rate was improved from (2.7 ± 0.8) ml / s to (15.7 ± 2.1) ml / s preoperatively and (16.1 ± 2.1) ml / s after 3 months. The IPSS score improved from preoperative (28.7 ± 5.1) to (10.2 ± 5.4) at postoperative catheterization and (8.8 ± 5.4) at 3 months postoperatively from QOL 0.5) was improved to (2.1 ± 1.7) after extubation and (1.8 ± 1.7) points at 3 months after operation. No recurrence of urethral stricture was found in 47 patients after removal of the catheter, and three patients had recurrent urethral stricture, Among them, one case had urinary incontinence one week after removal of the catheter, and 50 cases underwent dialysis regularly after urethral catheterization. If necessary, cystoscopy was used to treat the urethra, which was improved after urinary excretion. Conclusion: Transurethral 2 μm laser urethrotomy is a good and appropriate method for the treatment of traumatic urethral stricture or atresia.