[1]王泽民** 李静① 王志勇 李俊鹏 王海龙.超声监视球囊扩张治疗老年等离子前列腺切除术后尿道狭窄的近期效果[J].中国微创外科杂志,2021,01(1):23-26.
　Wang Zemin*,Li Jing,Wang Zhiyong*,et al.Shortterm Effect of Ultrasound Monitoring Balloon Dilatation on Urethral Stricture After Plasma Prostatectomy in the Elderly[J].Chinese Journal of Minimally Invasive Surgery,2021,01(1):23-26.
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超声监视球囊扩张治疗老年等离子前列腺切除术后尿道狭窄的近期效果()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年1期
页码:
23-26
栏目:
临床研究
出版日期:
2021-02-26

文章信息/Info

Title:
Shortterm Effect of Ultrasound Monitoring Balloon Dilatation on Urethral Stricture After Plasma Prostatectomy in the Elderly
作者:
王泽民** 李静① 王志勇 李俊鹏 王海龙
（承德医学院附属医院泌尿外科，承德067000）
Author(s):
Wang Zemin*;  Li Jing;  Wang Zhiyong*;  et al.
*Department of Urology, Affiliated Hospital of Chengde Medical College, Chengde 067000, China
关键词:
高压球囊扩张; 尿道狭窄; 老年患者
Keywords:
Balloon dilatation; Urethral stricture; Elderly patients
文献标志码:
A
摘要:
目的探讨超声监视高压球囊扩张(balloon dilation，BD)治疗老年患者经尿道双极等离子前列腺切除术（transurethral plasma kinetic prostatectomy，TUPKP）后尿道狭窄的近期临床效果。方法2016年6月~2019年1月我院20例老年TUPKP术后尿道狭窄接受超声监视BD治疗。亲水导丝通过尿道狭窄段进入膀胱，以导丝为引导引入等离子勾状刀将狭窄段尿道切开，使高压(30 atm)球囊导管顺利进入尿道狭窄部位，在超声实时监测下，精确定位、掌控高压球囊扩张全过程，使狭窄段尿道安全、有效地扩张。结果手术时间（31.1±6.5）min，术中出血量（12.4±5.2）ml，保留尿管时间（27±0.7）d，住院时间（6.8±1.7）d。术后3个月最大尿流率（19.2±2.1）ml/s，较术前（7.2±1.2）ml/s明显升高（t=-23.875，P=0.000）；术后3个月平均尿流率（10.5±1.2）ml/s，明显高于术前（3.9±0.8）ml/s（t=-18.051，P=0.000）；术后3个月残余尿量（21.9±6.8）ml，较术前（107.8±46.2）ml明显降低（t=9.062，P=0.000）；术后3个月国际前列腺症状评分（5.4±16）分，较术前（25.1±2.8）分明显降低（t=25.997，P=0.000）；术后3个月生活质量评分（1.9±0.8）分，较术前（4.8±0.9）分明显降低（t=11.588，P=0.000）；术后3个月膀胱过度活动调查评分（48.0±7.1）分，较术前（78.3±7.8）分明显降低（t=10.331,P=0.000）；术后6个月国际勃起功能指数问卷表-5评分（7.3±1.8）分，与术前（7.5±1.8）分比较差异无显著（t=1831，P=0.083）。拔除尿管后发生尿失禁1例，协助排尿功能锻炼后症状好转；术后1年内尿道狭窄复发1例，行尿道狭窄内切开术治疗。结论超声监视BD治疗老年TUPKP术后尿道狭窄，安全、有效地改善患者近期排尿功能，改善术后生活质量。
Abstract:
ObjectiveTo investigate the shortterm effect of ultrasound monitoring balloon dilatation(BD) on urethral stricture after transurethral plasma kinetic prostatectomy (TUPKP) in elderly patients.MethodsFrom June 2016 to January 2019, 20 elderly patients with urethral stricture after TUPKP were treated with ultrasound monitoring BD. The hydrophilic guide wire was entered the urethral stricture segment, and a plasma hook knife was used to open the stricture segment so the highpressure(30 atm) balloon catheter could enter the urethral stricture site. Under the realtime ultrasonic monitoring, accurate positioning and control of the highpressure BD made the urethra stricture expanding safely and effectively.ResultsThe operation time was (31.1±6.5) min, the intraoperative blood loss was (12.4±5.2) ml, the catheter retention time was (2.7±0.7) d, and the hospital stay was (68±1.7) d. Three months later, the Qmax ［(19.2±2.1) ml/s］ was significantly higher than preoperative level ［(7.2±1.2) ml/s, t=-23.875, P=0.000］, the Qave ［(10.5±1.2) ml/s］ was significantly higher than preoperative level ［(3.9±0.8) ml/s, t=-18.051, P=0.000］, the residual urine volume(RUV) ［(21.9±6.8) ml］ was significantly lower than preoperative level ［(107.8±46.2) ml, t=9.062, P=0.000］, the International Prostate Syndrome Score(IPSS)［(5.4±1.6) points］ was lower than preoperative level ［(25.1±2.8) points, t=25.997, P=0.000］, the quality of life(QOL) score ［(1.9±0.8) points］ was lower than preoperative level ［(4.8±0.9) points, t=11.588, P=0.000］, and the Questionnaire for Overactive Bladder(OABq) score ［(48.0±7.1) points］ was lower than preoperative level ［(78.3±7.8) points, t=10.331, P=0.000］. Six months later, the International Index of Erectile Function5(IIEF5) score ［(7.3±1.8) points］ had no significant difference as comparing to preoperative level ［(7.5±1.8) points, t=1.831, P=0.083］. One case of urinary incontinence occurred after removal of the urinary tube, but the symptoms improved with the exercise of urination function. Postoperatively 1 case of urethral stricture recurred and was treated by endotomy. ConclusionUltrasonic monitoring BD for urethral stricture after TUPKP in elderly patients is safe and effective in improving patients’ urination function and postoperative quality of life.

参考文献/References:

[1]Chung JH, Kim KS, Choi JD, et al. Effects of poloxamerbased thermosensitive solgel agent on urethral stricture after transurethral resection of the prostate for benign prostatic hyperplasia: a multicentre, singleblinded, randomised controlled trial. BJU Int,2020,125(1):160-167.
[2]Yagi S, Goto T, Kawamoto K, et al. Longterm results of percutaneous balloon dilation for ureterointestinal anastomotic strictures. Int J Urol,2002,9(5):241-246.
[3]Vyas JB, Ganpule AP, Muthu V, et al. Balloon dilatation for male urethral strictures "revisited". Urol Ann,2013,5(4):245-248.
[4]马俊海,范宁,鲁骋洲,等.经尿道前列腺电切术中冲洗液吸收量和出血量的监测研究.中华泌尿外科杂志,2019,40(1):37-41.
[5]王建龙,陈毅来,王蕾蕾,等.老年前列腺增生患者经尿道绿激光气化切除术后储尿期症状改善的多因素分析.中华老年医学杂志,2019,38(2):196-200.
[6]Gelman J, Liss MA, Cinman NM. Direct vision balloon dilation for the management of urethral strictures. J Endourol,2011,25(8):1249-1251.
[7]Stamatiou K, Christopoulos G, Moschouris H, et al. Treatment of urethral strictures with balloon dilation: A forgotten tale. Arch Ital Urol Androl,2015,87(3):254-255.
[8]Barbalias D, Lappas G, Ravazoula P, et al. Evaluation of the distribution of paclitaxel after application of a paclitaxelcoated balloon in the rabbit urethra. J Endourol,2018,32(5):381-386.
[9]Akkoc A, Aydin C, Kartalms M, et al. Use and outcomes of amplatz renal dilator for treatment of urethral strictures. Int Braz J Urol,2016,42(2):356-364.
[10]Matsukawa Y, Takai S, Majima T, et al. Comparison in the efficacy of fesoterodine or mirabegron addon therapy to silodosin for patients with benign prostatic hyperplasia complicated by overactive bladder: A randomized, prospective trial using urodynamic studies. Neurourol Urodyn,2019,38(3):941-949.
[11]Stormont TJ, Suman VJ, Oesterling JE. Newly diagnosed bulbar urethral strictures: etiology and outcome of various treatments. J Urol,1993,150(5 Pt 2):1725-1728.
[12]Tonkin JB, Jordan GH. Management of distal anterior urethral strictures. Nat Rev Urol,2009,6(10):533-538.
[13]常艳华,王会,李旭东,等.经尿道前列腺扩裂术治疗中年前列腺增生致急性尿潴留的疗效.中国微创外科杂志,2018,18(9):819-821.
[14]杨明.食管覆膜支架置入术和球囊扩张术在治疗中晚期食管癌中的临床价值探讨.影像研究与医学应用,2020,4(9):8-10.
[15]贾斌,付凤林,周玉石,等.经尿道柱状水囊前列腺扩开术治疗良性前列腺增生30例.中国微创外科杂志,2019,19(4):319-321.

备注/Memo

备注/Memo:
基金项目：2017年承德市科学技术研究与发展计划项目（201701A058）**通讯作者，Email:gongpingcun4@163.com ①超声科
更新日期/Last Update: 2021-04-02