CAJ | 학술논문

目的探讨钬激光尿道内切开术联合瘢痕电切术治疗小儿尿道狭窄的疗效及安全性.方法对2009年4月至2011年4月收治的48例男性尿道狭窄的患儿,进行钬激光尿道内切开术联合瘢痕电切术,年龄2～15岁,平均5.2岁；病程1个月至2年,平均5个月.记录尿失禁、尿外渗及继发出血等并发症发生情况和狭窄复发率,并联合超声尿流率测定评估疗效和进行为期1年随访.结果患儿手术均顺利,无尿失禁、尿外渗,无继发出血等并发症.拔尿管后2周随访时,最大尿流率和平均尿流率分别为(18.5±4.3)ml/s和(10.4±3.7)ml/s,均显著高于术前(5.2±2.1)ml/s和(3.8±0.7)ml/s,尿流时间为(10.9±4.9)s,显著低于术前(14.6±4.2)s,差异有统计学意义；但8例(16.7％)尿流率测定仍提示尿道梗阻,其中6例进行定期扩张尿道,2例再次钬激光尿道内切开术治疗后定期扩张尿道.共计44例(91.7％)完成1年随访,一次性治愈率达83％.结论钬激光尿道内切开术联合瘢痕电切术具有微创、术后复发率低的优点,是治疗小儿尿道狭窄安全有效的方法之一；尿流率测定有助于术后早期鉴别再次尿道狭窄患儿.
목적 탐토화격광뇨도내절개술연합반흔전절술치료소인뇨도협착적료효급안전성.방법 대2009년4월지2011년4월수치적48례남성뇨도협착적환인,진행화격광뇨도내절개술연합반흔전절술,년령2～15세,평균5.2세；병정1개월지2년,평균5개월.기록뇨실금、뇨외삼급계발출혈등병발증발생정황화협착복발솔,병연합초성뇨류솔측정평고료효화진행위기1년수방.결과 환인수술균순리,무뇨실금、뇨외삼,무계발출혈등병발증.발뇨관후2주수방시,최대뇨류솔화평균뇨류솔분별위(18.5±4.3)ml/s화(10.4±3.7)ml/s,균현저고우술전(5.2±2.1)ml/s화(3.8±0.7)ml/s,뇨류시간위(10.9±4.9)s,현저저우술전(14.6±4.2)s,차이유통계학의의；단8례(16.7％)뇨류솔측정잉제시뇨도경조,기중6례진행정기확장뇨도,2례재차화격광뇨도내절개술치료후정기확장뇨도.공계44례(91.7％)완성1년수방,일차성치유솔체83％.결론 화격광뇨도내절개술연합반흔전절술구유미창、술후복발솔저적우점,시치료소인뇨도협착안전유효적방법지일；뇨류솔측정유조우술후조기감별재차뇨도협착환인.
Objective To evluate the clinical efficacy and safety of holmium laser combined with transurethral electroic incision in children with urethral stricture. Methods From April 2009 to April 2011, 48 patients with urethral stricture underwent holmium laser combined with transurethral electroic incision in our centre. The average age of them was 5.2 years old (ranging from 2 to 15 years old). The course of disease lasted averagely 5 months (1 month to 2 years). The complications were recorded including urinary incontinence, urinous infiltration, and secondary hemorrhage, etc. The uroflowmetry and ultrasound were used to evaluate therapeutic outcomes. The follow-up time was 1 year. Results The surgery was successfully conducted in all cases and no complications were found in them. The maximal flow rate and average flow rate after surgery were respective (18.5 ± 4.3 ml/s)and (10.4 ± 3.7 ml/s), which was significantly higher than those in pre-operation (5.2 ± 2.1ml/s and 3.8 ± 0.7ml/s) respectively. The flow time was 10.9 ± 4.9 s, which was lower than that in pre-operation (14.6± 4.2 s). Although these, urethral obstruction was found in 8 cases (16.7％), in which 6 cases of them underwent periodically completed urethral dilatation, and 2 cases underwent secondary holmium laser incision. Totally 44 cases were followed up for one year, and the cure rate for them was up to 83％ . Conclusions Holmium laser incision combined with electro-incision for children with urethral stricture is one of safe and effective minimally invasive therapeutic approaches, and uroflowmetry contributes to early identify recurrent urethral stricture.