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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94.1%)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37.9%),10例(占34.5%)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 investigate the curative effect of urethral valve disease after holmium laser treatment and to summarize clinical experience and to promote the application of holmium laser in posterior urethral valve disease. Methods Twenty-nine patients with posterior urethral valvular disease were all male, underwent cysto-urethrography, intravenous urography and transurethral ureteroscopy. All anesthesia, bladder lithotomy position, the use of holmium laser TV monitoring of the posterior urethral valve resection point by point, and then check the posterior urethra, urethral patency, removal of the mirror. Squeeze the pubic bone on the bladder surface, see flushing urine outflow from the urethra, urine significantly thicker than the previous. Postoperative anti-inflammatory, fluid replacement and symptomatic treatment. Indwelling catheter 2 d ~ 1 week range, and indwelling bladder fistula. The results of holmium laser posterior urethral valve resection, intraoperative diagnosis of urethral valve type are type I, the operation was almost no bleeding, the operation time is short, easy to operate. After 3 months to 2 years of follow-up, 24 cases underwent transurethral ureteroscopic holmium laser surgery for 1 time. The symptoms of micturition relieved and delayed the expansion of the upper urinary tract. Manifested as: improved hydronephrosis, B-follow-up double renal and ureteral dilatation were improved to varying degrees, residual urine are small, six months follow-up urinary flow rate, maximum flow rate, average flow rate were significantly higher than urinary Preoperative urination time was significantly shorter than preoperative. No improvement was found in 5 cases. Secondary urethral laser urethral valve excision was performed. The postoperative urinary flow rate was in the range of 7-18 mL / s. The results of urodynamic examination in this group of patients showed that in 29 cases, 16 cases (94.1%) had varying degrees of bladder dysfunction, urodynamic examination showed decreased compliance, detrusor instability (37.9%), , 10 cases (34.5%) increased residual urine. Conclusion Transurethral holmium laser posterior urethral valve is a safe, minimally invasive and effective treatment of posterior urethral valve means, it is worth promoting.