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目的观察输尿管镜联合钬激光治疗男性尿道狭窄的临床效果和安全性。方法选择2008年10月—2011年10月收治的男性尿道狭窄患者105例,随机分为钬激光组52例和冷刀内切组53例,钬激光组采用钬激光治疗仪连接F21专用膀胱镜鞘,在电视视频引导下插入输尿管导管作为引导,然后在膀胱镜操作孔插入钬激光光纤,根据前尿道狭窄和后尿道狭窄情况选择切口部位,常规切除隆起瘢痕;冷刀内切组采用经尿道冷刀内切开术治疗。观察两组手术时间、术中出血量、最大尿流率、平均住院时间、复发率、再手术率及术后并发症发生情况。计量资料用x±s表示,采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果手术时间钬激光组(29.7±6.2)min,冷刀内切组(21.6±5.7)min;术中出血量钬激光组(10.5±7.8)ml,冷刀内切组(23.6±8.3)ml;最大尿流率钬激光组(16.1±2.8)ml/s,冷刀内切组(11.9±3.1)ml/s;平均住院时间钬激光组(4.2±0.7)d,冷刀内切组(4.5±0.8)d;两组各指标比较差异均有统计学意义(t=6.971、8.331、7.281、2.043,均P<0.05)。随访1年,狭窄复发率钬激光组15.4%,冷刀内切组37.7%,两组比较差异有统计学意义(χ2=6.705,P<0.05)。再手术钬激光组9.62%,冷刀内切组28.3%,两组比较差异有统计学意义(χ2=5.944,P<0.05)。并发症发生率钬激光组1.92%,冷刀内切组18.87%,两组比较差异有统计学意义(χ2=8.036,P<0.05)。结论输尿管镜联合钬激光能够明显提高男性尿道狭窄的临床治疗效果,在改善患者生存质量和降低复发率方面意义重大,值得推广。
Objective To observe the clinical effect and safety of ureteroscope combined with holmium laser in treating male urethral stricture. Methods 105 patients with male urethral stricture who were admitted from October 2008 to October 2011 were randomly divided into holmium laser group (n = 52) and cold knife internalization group (n = 53). The holmium laser group was treated with holmium laser and treated with F21 special cystoscope The sheath was inserted into the ureter catheter as a guide under the guidance of the video of the TV and the holmium laser fiber was inserted into the operation hole of the cystoscope. The incision site was selected according to the anterior urethral stricture and posterior urethral stricture. Cold knife incision surgery. The operation time, intraoperative blood loss, maximum uroflow rate, average length of hospital stay, recurrence rate, rate of reoperation and postoperative complications were observed. Measurement data with x ± s, said t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The operative time was 29.7 ± 6.2min in the holmium laser group and 21.6 ± 5.7min in the cold knife group, and 10.5 ± 7.8ml in the holmium laser group and 23.6 ± 8.3ml in the cold knife group ; The maximal uroflow rate of holmium laser group (16.1 ± 2.8) ml / s, cold knife internalization group (11.9 ± 3.1) ml / s; mean length of stay holmium laser group (4.2 ± 0.7) d, 4.5 ± 0.8) d. The differences between the two groups were statistically significant (t = 6.971, 8.331, 7.281, 2.043, all P <0.05). After one year of follow-up, there was a significant difference between the two groups (χ2 = 6.705, P <0.05). 9.62% in the group of holmium laser and 28.3% in the cold knife group after reoperation. There was significant difference between the two groups (χ2 = 5.944, P <0.05). Complication rates were 1.92% in the holmium laser group and 18.87% in the cold knife internalization group, with significant difference between the two groups (χ2 = 8.036, P <0.05). Conclusions Ureteroscopy combined with holmium laser can significantly improve the clinical efficacy of male urethral stricture, which is of great significance in improving the quality of life and reducing the recurrence rate of patients, which is worthy of promotion.