Early reports of the application of thulium laser for treatment of high tension neurogenic bladder by transurethral approach
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摘要: 目的:研究铥激光经尿道膀胱内肌层网状全层切开术治疗高张力性神经源性膀胱的可行性。方法:3例高张力小容量神经源性膀胱患者,男2例,分别为29岁、40岁,分别患先天性脊膜膨出、椎管室管膜瘤;女1例,21岁,患脊髓栓系综合征。3例患者均行常规尿动力学检查及逆行膀胱造影提示小容量高张力性神经源性膀胱。手术均在全麻下进行,患者取截石位,经尿道置入膀胱腔内操作器械,采用1 900 nm的Vela激光直射光纤,能量为40 W,低压观察膀胱内壁后,在膀胱三角区以外的膀胱壁呈网状多处全层切开膀胱肌层,直至显露肌层外方浆膜层,或多处切开膀胱壁小梁,注意保护膀胱肌层的血运。术后留置膀胱冲洗1天,术后1周评价治疗效果。结果:1例患者取得满意效果,术后复查尿动力学检查及逆行膀胱造影,膀胱容量明显增加,储尿期膀胱内压降低,能依靠腹压自主排尿,无明显剩余尿。另2例患者排尿症状、膀胱容量及输尿管反流情况无明显改善。结论:铥激光经尿道膀胱内肌层网状全层切开术治疗高张力性神经源性膀胱对部分患者具有一定的疗效,但病例的选择以及疗效的持续时间,还需积累更多的病例观察。Abstract: Objective: To study the feasibility of thulium laser for treatment of high tension neurogenic bladder by transurethral approach.Method: Three cases were diagnosed as high tension and small capacity neurogenic bladder including two males and one female. One man was 29 years old with congenital spinal meningocele, and the other was 40 years old with spinal canal ependymoma. The woman was 21 years old with tethered cord syndrome. All patients were performed routine urodynamics test and retrograde cystography. All operations were performed under general anesthesia with lithotomy position. We placed 1900 nm Vela laser direct optical fiber into bladder by lumen equipment. After observing the bladder wall, we radially split full-thickness bladder muscle and cut off bladder wall trabecular, except trigone and neck, with 40W laser energy in low pressure. We paid attention to protect the blood supply of the bladder muscle layer. Bladder irrigation were kept for one day. We assessed therapeutic effect one week later.Result: One case got satisfactory effect. Postoperative urodynamics test and the retrograde bladder radiography showed the bladder capacity significantly increased and storage bladder pressure reduced. The patient also could rely on abdominal pressure to experience automatic micturition. No obvious residual urine was found. The other two patients weren't found obvious improvement in urination, bladder capacity and ureteral reflux condition.Conclusion: Using thulium laser to split full-thickness bladder muscle by transurethral approach for treatment of high tension neurogenic bladder shows certain curative effect, but the choice of cases, as well as the duration of the effect, still need to accumulate more cases to observe.
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Key words:
- thulium laser /
- neurogenic bladder
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