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目的探讨激光治疗尿道狭窄的方法及疗效。方法对不完全性尿道闭锁者先导入输尿管导管,用Nd:YAG接触式激光汽化切割尿道瘢痕组织,对于闭锁段<1cm尿道完全闭锁者,用接触式激光沿尿道正道同一轴线方向打通尿道,再切割瘢痕组织;若闭锁段>1cm,则沿造瘘口下缘切开2 cm,左手食指伸入直肠内引导尿道探子紧贴耻骨下缘钻通闭锁段尿道,助手以手指经瘘口伸入后尿道协助引导尿道探子尖端进入膀胱,依次扩张尿道至24F,再用接触式激光汽化切除瘢痕组织,术后定期尿道扩张,分别于术后3、6、12个月随访。结果全部病例排尿顺畅,术后1 年IPSS评分平均减少20．5分,生活质量评分减少3．8分,最大尿流率增加10.6 ml／s,剩余尿量减少 258．8 ml。与术前比较,差异有统计学意义(P<0．01)。结论经尿道Nd:YAG激光切除尿道瘢痕结合术后尿道扩张治疗尿道狭窄,是治疗尿道狭窄较好的方法。
Objective To investigate the method and effect of laser treatment of urethral stricture. Methods Ureteral catheter was introduced into incomplete urethral atresia. Urethral scar tissue was excised by Nd: YAG contact laser vaporization. For patients with complete occlusion of urethra less than 1 cm in diameter, the urethra was opened with the contact laser along the same axis of the urethra Cut the scar tissue; if the lock segment> 1cm, along the lower edge of the stoma incision 2cm, the left index finger into the rectum to guide the urethra probe close to the lower edge of the pubic bone drilling through the urethra, the assistant finger to enter through the fistula The posterior urethra assists in guiding the tip of the urethral probe into the bladder, sequentially expanding the urethra to 24F, and then removing the scar tissue by contact laser vaporization. Regular post-urethral dilatation is followed up at 3, 6, and 12 months after operation. Results All patients had voiding smoothly. The IPSS score decreased by 20.5 points on average after 1 year, the quality of life score decreased by 3.8 points, the maximum uroflow rate increased by 10.6 ml / s and the residual urine volume decreased by 258.8 ml. Compared with preoperative, the difference was statistically significant (P <0.01). Conclusion Transurethral Nd: YAG laser resection of urethral scar combined with postoperative urethral dilatation for the treatment of urethral stricture is a good method for the treatment of urethral stricture.