CAJ | 학술논문

目的：探讨经尿道逆行输尿管硬镜结合经膀胱造瘘处顺行膀胱软镜联合肾穿刺针、钬激光和球囊扩张导管治疗成年男性尿道闭锁的临床疗效。方法从尿道及膀胱造瘘口各置入输尿管镜、膀胱软镜分别观察闭锁段远近端，在双镜监视下，以肾穿刺针从闭锁段远端穿刺至闭锁段近端以确定正道，钬激光切开闭锁段后再用球囊扩张导管高压扩张闭锁尿道。采用上述方法治疗尿道闭锁的13例成年男性患者尿道闭锁段均位于尿道膜部和／或球部，闭锁段长度0．5～1．8 cm，中位数1．2 cm。结果13例手术全部成功，平均手术时间55min 术中平均失血11．2 mL。随访3个月～2年，3例患者3～6月后出现尿线变细，予尿道扩张数次后排尿症状明显改善，未再次手术。其余患者均排尿通畅。结论顺逆行双镜联合肾穿刺针、钬激光和球囊扩张导管治疗男性尿道闭锁操作简单、安全、有效，并可重复操作。
목적：탐토경뇨도역행수뇨관경경결합경방광조루처순행방광연경연합신천자침、화격광화구낭확장도관치료성년남성뇨도폐쇄적림상료효。방법종뇨도급방광조루구각치입수뇨관경、방광연경분별관찰폐쇄단원근단，재쌍경감시하，이신천자침종폐쇄단원단천자지폐쇄단근단이학정정도，화격광절개폐쇄단후재용구낭확장도관고압확장폐쇄뇨도。채용상술방법치료뇨도폐쇄적13례성년남성환자뇨도폐쇄단균위우뇨도막부화／혹구부，폐쇄단장도0．5～1．8 cm，중위수1．2 cm。결과13례수술전부성공，평균수술시간55min 술중평균실혈11．2 mL。수방3개월～2년，3례환자3～6월후출현뇨선변세，여뇨도확장수차후배뇨증상명현개선，미재차수술。기여환자균배뇨통창。결론순역행쌍경연합신천자침、화격광화구낭확장도관치료남성뇨도폐쇄조작간단、안전、유효，병가중복조작。
Objective To evaluate the therapeutic efficiency of the operation with multiple endoscopy and renal puncture needle, holmium laser, balloon catheter for atresia of urethra.Method Thirteen adult male patients with atresia of urethra underwent the operation with double ureteroscopes and renal puncture needle, Holmium Laser, balloon catheter.The atresia length ranged from 0.5 to 1.8 cm.A renal puncture needle was punctured from the distal-end to the proximal-end monitored with two ureteroscopes (one observing the proximal-end of atresia through bladder fistula and the other observing the distalend through urethral orifice) to determine the right lumen of atresia of urethra.After that, dilation of urethra by holmium Laser, balloon catheter and transurethral resection were followed for 4 weeks.Findings The operations with double ureteroscopes and renal puncture needle, holmium laser, balloon catheter for all patients with atresia of urethra were successful.The mean operative time was 55 min(45 ~95).The mean blood loss was11.2mL( 5 ~20 mL).No severe complication occurred.The patients were followed up 6 ~24 months after treatment.All were found to have smooth urination.Conclusion The operation with double ureteroscopes and renal puncture needle, holmium laser, balloon catheter for atresia of urethra is simple,safe,effective,and replicable.