人工尿道括约肌植入术治疗创伤性尿道损伤后尿失禁的长期随访(附17例报告)  

Artificial urinary sphincter implantation for post-traumatic sphincter incontinence:a single center outcomes and experience with 17 patients

作　　者：张帆[1,2,3] 廖利民[1,2,3] 付光[1,2,3] 鞠彦合[1,2,3] 李东[1,2,3] 熊宗胜[1,2,3] 韩春生[1,2,3] 史文博[1,2,3] 陈国庆[1,2,3] ZHANG Fan LIAO Limin FU Guang JU Yanhe LI Dong XIONG Zongsheng HAN Chunsheng SHI Wenbo CHEN Guoqing(Department of Urology, China Rehabilitation Research Center, School of Rehabilitation Medicine of Capital Medical University, Beijing, 100068, China)

机构地区：[1]中国康复研究中心北京博爱医院泌尿外科,北京100068 [2]首都医科大学泌尿外科学系 [3]首都医科大学康复医学系

出　　处：《临床泌尿外科杂志》2016年第12期1060-1063,共4页Journal of Clinical Urology

摘　　要：目的：总结人工尿道括约肌（AUS）植入用于治疗尿道外伤后尿失禁的经验。方法：回顾性分析我中心2002年4月-2015年12月收治的17例尿道外伤后尿失禁行AUS植入的患者临床资料。患者平均年龄40.29岁,男16例,女1例。其中骨盆骨折尿道断裂患者16例,骑跨伤导致尿道断裂1例。术前作为尿道重建手术的一部分,其中3例行尿道括约肌切断术,5例行尿道扩张术,2例行尿道狭窄切开术。对前期尿道修复手术准备、括约肌植入术后并发症处理及患者尿失禁和生活质量改善情况进行观察评价。结果：17例患者中术后1个月均成功激活装置并正常使用,14例患者能达到社交控尿水平（每日使用尿垫2片及以下）,其中8例患者可达到完全干燥,总体手术成功率达到82.3%（14/17）。患者尿垫使用量显著下降（术前3.62±0.35片/d,术后1.29±0.31片/d,P〈0.01）;尿失禁影响生活质量评分（VAS）显著改善（术前6.75±0.36,术后1.86±0.63,P〈0.01）。术后并发症发生率为23.5%,其中感染1例,局部溶蚀2例,机械故障1例。平均随访时间40.8（13-144）个月。截止最近一次随访,13例患者仍然使用初次安装的括约肌装置,2例患者行一次修复手术,2例患者因术后并发症取出装置。结论：尿道外伤后尿失禁的治疗需根据患者个体情况制定手术方案。AUS植入作为一系列尿路重建手术中的重要步骤,是安全、有效的。Objective：To present the experience of artificial urinary sphincter（AUS）implantation for patients with post-traumatic sphincter incontinence.Method：Between April 2002 and December 2015,a total of 17patients（median age,40.29 years old,pelvic fracture-associated urethral injuries n=16,straddle injury n=1）with urinary incontinence（UI）secondary to urethral injury had undergone AUS placement.Necessary surgeries were conducted before AUS placement as stage procedures,including urethral dilation（n=5）,urethral strictures incision（n=2）,and sphincterotomy（n=3）.Preoperative preparations,postoperative complications,and quality of daily life were evaluated.Result：AUS devices were successfully activated and used in all 17 cases at 1-month after surgery.Fourteen patients were socially continent（less than two pads use per day）,of which eight patients were totally dry,leading to the overall success rate as 82.3%（14/17）.The daily pad count dropped from（3.62±0.35）to（1.29±0.31）pads per day（P〈0.01）.The impact of incontinence on the QoL measured by the VAS dropped from（6.75±0.36）to（1.86±0.63）（P〈0.01）.The overall complication rate was 23.5%including infection（n=1）,erosions（n=2）and mechanical failure（n=1）.The mean follow-up period was 40.8（range,13-144）months.At the latest visit,13 patients maintained the primary AUS.Two patients had revisions.Explantations were performed in two patients.Conclusion：AUS implantation is a safe and effective treatment for post-traumatic sphincter incontinence.Stage procedure is needed especially in complicated cases.

关 键 词：人工尿道括约肌植入术 尿道外伤后尿失禁 尿路重建 并发症 随访 

分 类 号：R699.6[医药卫生—泌尿科学]