尿道狭窄手术方式与术后复发

尿道狭窄手术方式与术后复发 [摘要] 目的选择尿道狭窄最佳治疗方法,减少术后复发。方法回顾经尿道瘢痕切除治疗男性尿道狭窄患者21例,按尿道狭窄长度分为A组(≤1.0cm)和B组(>1.0cm),比较两组患者术中出血量、手术时间、术后最大尿流和术后复发率。结果21例手术中瘢痕彻底切除,尿道均扩张至26F。两组出血量、手术时间和术后最大尿流间比较差异无统计学意义(P>0.05);术后除B组1例失访外,其余20例随访3~36个月;有8例(40.0%)复发,其中A组复发1例(11.1%),B组复发7例(63.6%)(P1.0cm,应行尿道成形术。 [关键词] 尿道狭窄;内腔镜治疗;尿道成形;狭窄复发 [中图分类号] R699 [文献标识码] B [文章编号] 2095-0616(2014)04-188-03 Surgical methods of urethral stricture and postoperative recurrence RAN Jinsheng SU Shuguang Department of Urology,Geriatric Hospital of Tongzhou District,Beijing 101111,China [Abstract] Objective To explore the best surgical method for urethral stricture in order to reduce postoperative recurrence. Methods Clinical data of 21 patients with urethral stricture treated by transurethral scar excision was retrospectively analyzed.The patients were divided into group A (≤1.0 cm)and group B (>1.0 cm)based on their urethral stricture length and compared in blood loss,operative duration, postoperative maximum urine flow and postoperative recurrence. Results The scars of 21 patients were completely removed and urinary tracts were dilated to 26F.There was no significant difference in blood loss, operative duration and postoperative maximum urine flow in two groups (P>0.05). The other 20 patients were followed up for 3 to 36 months other than 1 case in group B.Urethral stricture reoccurred in 8 patients with 1 case in group A (11.1%)and 7 cases in group B (63.3%)(P<0.05). Conclusion The postoperative recurrence rate is lower with ureteroscopic surgery when the length of urethral stricture is no more than 1.0 cm; the urethroplasty should be performed when the length of urethral stricture is beyond 1.0 cm. [Key words] Urethral stricture;Ureteroscopic treatment;Urethroplasty;Stricture recurrence 尿道狭窄术后复发一直是临床所面临的难题 [1-2],在众多导致复发的原因中,手术方式选择不当可能是一重要原因。本研究自2008年3月~2011年12月采用经尿道等离子刀瘢痕切除术,术后定期尿道扩张治疗尿道瘢痕狭窄21例,现报道如下。 1 资料与方法 1.1 一般资料 本组资料21例均为男性,年龄23~78岁,平均(40.8±14.7)岁。按尿道狭窄长度分为2组,A组狭窄段≤1.0cm组,共9例,狭窄段最短0.4cm,年龄24~78岁,平均(41.8±13.5)岁;其中骑跨伤后尿道狭窄4例,经尿道切除术后狭窄2例,尿道炎后1例,导尿后1例,骨盆骨折后1例;后尿道狭窄3例,球部狭窄4例,阴茎部狭窄2例。B组为狭窄段>1.0cm,共12例,狭窄段最长3.1cm,其中狭窄长度>2.0cm 2例。年龄23~77岁,平均(39.9±12.4)岁。其中骑跨伤后尿道狭窄4例,经尿道切除术后狭窄3例,尿道炎后2例,导尿后2例,骨盆骨折后1例;后尿道狭窄3例,球部狭窄6例,阴茎部狭窄3例。经统计, 两组患者年龄、病情、病因组间无显著性差异 (P>0.05)。 1.2 治疗方法 所有患者均采用英国佳乐等离子电切镜及狼牌尿道镜;硬膜外麻醉;截石体位。先经尿道镜向狭窄尿道孔插入输尿管导管,顺利插入5~10cm证实其在尿道腔内,拔出尿道镜,放入等离子电切镜。在输尿管导管的引导下逆行点击式电切,并向前推镜。目镜越过狭窄段尿道后向后退镜,清除残留瘢痕。术后保留22F气囊导尿管30d左右,拔管后定期行尿道扩张。随访3~36个月。