摘要
目的:初步评价置入Allium球部尿道支架治疗男性复发性复杂尿道狭窄的疗效及并发症。方法:回顾性分析2020年2月至2022年12月厦门大学附属第一医院收治的外伤骨盆骨折术后患者15例,其中14例曾行尿道成形术,1例行尿道狭窄内切开术2次,8例有多次尿道狭窄球囊扩张病史。采用全麻下经尿道输尿管镜下球囊扩张尿道狭窄后置入Allium支架,7例患者经会阴部固定支架,8例未行固定。术后第一天夹闭膀胱造瘘管,开始观察患者的排尿情况,并行骨盆平片了解Allium支架位置。门诊随访尿流率,观察疗效及并发症发生情况。结果:13例患者术后第1天即可排尿,8例患者术后4d~3个月因支架发生远端移位进行调整或更换新支架,其中包括2例之前已行支架固定的患者,2例出现排尿不适,1例发生明显肉眼血尿,4例术后息肉堵塞支架,1例支架内膜多发细小结石。留置时间为2~11个月,平均5.5个月,平均随访11.9个月(2~24个月),术后最大尿流率(Qmax)平均值为10.6ml/s,排尿满意者8例(53.3%)。结论:Allium球部尿道支架治疗失败的主要原因与术后支架移位有关,可临时用于治疗尿道成形术后复发而不愿或不适宜手术的患者。
Objective:To evaluate the efficacy and complications of Allium polymer-coated metal stent in the treatment of recurrent complex urethral stricture.Methods:The data of 15 patients suffered traumatic pelvic fractures after operation with urethral stricture admitted to the First Affiliated Hospital of Xiamen University from February 2020 to December 2022 were retrospectively analyzed,14 of them had undergone urethroplasty,1 had undergone internal urethrotomy for 2 times,and 8 had a history of multiple balloon dilatation of urethral stricture.Allium stent was inserted after balloon dilatation of urethral stricture under ureteroscopy under general anesthesia.Seven patients were fixed with Allium stent and 8 patients were not fixed.On the first postoperative day,the bladder stoma was clamped,the urination of the patient was observed,and the position of the Allium stent was determined by pelvic plain film.The urine flow rate was followed up in the outpatient clinic,and the efficacy and complications were observed.Results:13 patients were able to urinate on the first day after the operation,8 patients were adjusted or replaced with new stents 4 days to 3 months after the operation due to distal displacement of stents,including 2 patients who had been fixed with stents before,2 patients had urination discomfort,1 patient had obvious gross hematuria,4 patients had polyps plugging stents,and 1 patient had multiple small stones in the stent intima.The mean follow-up time was 11.9 months(range 2~24 months).The mean maximum urinary flow rate was 10.6 ml/s,and 8 patients(53.3%)were satisfied with urination.So far,there was no urinary incontinence and no serious complications.Conclusion:The main cause of failure of Allium bulbar urethral stent is stent migration.Allium bulbar urethral stent can be used temporarily to treat patients who are unwilling or not suitable for surgery after urethroplasty.
作者
刘菲
陈跃东
曾彦恺
Liu Fei;Chen Yuedong;Zeng Yankai(Department of Urology,the First Affiliated Hospital of Xiamen University,Xiamen 361001,China)
出处
《微创泌尿外科杂志》
2023年第2期106-109,共4页
Journal of Minimally Invasive Urology
基金
福建省自然科学基金(2020J011249)
福建省卫健委创新基金(2020CXB046)
