目的 探讨钬激光治疗后尿道瓣膜疾病的疗效,总结临床经验,推广钬激光在后尿道瓣膜疾病中的应用。 方法 29例后尿道瓣膜症患者,均为男性,行膀胱尿道造影、静脉尿路造影、经尿道输尿管镜检查诊断。均采用全麻,取膀胱截石位,运用钬激光电视监视下将后尿道瓣膜逐个点烧灼切除,再次检查后尿道,后尿道通畅,撤镜。挤压耻骨上膀胱体表处,见冲水样尿液从尿道流出,尿线较前明显增粗。术后给予抗炎、补液及对症处理。留置导尿管2 d～1周不等,并留置膀胱造瘘管。 结果 行钬激光后尿道瓣膜切除术,术中诊断后尿道瓣膜类型均为I型,手术几乎无出血,手术时间短,操作方便。术后随访3个月至2年,24例行经尿道膀胱输尿管镜钬激光手术治疗1次后,排尿费力症状缓解,延缓上尿路扩张损害。表现为:双肾积水改善,B超随访双肾及输尿管扩张情况均不同程度好转,残余尿均较小,术后半年随访尿流率,最大尿流率、平均尿流率均明显高于术前,排尿时间较术前明显缩短。5例症状无改善,行二次钬激光后尿道瓣膜切除术,术后尿流率在7～18 mL/s范围。本组病例术后尿动力学检查结果示:29例中,16例(占9 1%)存在不同程度膀胱功能损害,尿动力学检查表现为顺应性降低,逼尿肌不稳定(占3 9%),10例(占3 5%)残余尿增多。 结论 经尿道钬激光治疗后尿道瓣膜是一种安全、微创、有效治疗后尿道瓣膜的手段,值得推广。
Objective To explore the efficacy of holmium laser for posterior urethral valve disease. Methods A total of 29 cases of posterior urethral valve disease were diagnosed by cystoscopy,intravenous urography and transurethral ureteroscopy. After general anesthesia,a position of lithotomy was adopted. Transurethral insertion of a 12F or 8F pediatric kidney endoscope was attempted. If the diagnosis was definite,valve position,thickness and its relationship with caruncle was determined. Holmium laser was employed for monitoring posterior urethral valve. Posterior urethra was unobstructed and removed. After squeezing the surface of suprapubic bladder,water sample was visible,urine oozed out of urethra and urinary line became thicker than before. Indwelling catheter,anti-inflammation,fluid replacement and symptomatic treatment were performed postoperatively. The duration of indwelling catheter was 2 days to 1 week. Bladder fistula was reserved. Results After transurethral resection,the type of posterior urethral valve was Young I. Operation had minimal bleeding and a short operative duration. At week 3 after indwelling catheterization,urinary bladder fistula was removed. During the follow-up period of 3～24 months,24 patients underwent transurethral ureteroscopic holmium laser surgery once and their symptoms of micturition became alleviated and dilatation of upper urinary tract was delayed. There was improvement of hydronephrosis. Ultrasonic follow-ups of double kidney and urethral dilatation improved to different extents and residual urine was lower after 6 months. Urine flow rate,maximal flow rate and average urinary flow rate were significantly higher than preoperative values and voiding time significantly shortened. No symptomatic improvement was found in 5 cases. Urethral resection was performed after two sessions of holmium laser. The postoperative urinary flow rate was 7～18 mL/s. The results of postoperative urodynamic examination indicated that 16/29 cases(9 1%)had varying degrees of bladder dysfunction and lowered compliance of detrusor instability(3 9%). And 10 cases(3 5%)had increased residual urine. Conclusion Transurethral Holmium laser treatment is safe,mini-invasive and effective for posterior urethral valve disease. And its wider popularization is recommended.
