改良尿道冲洗降低闭合性球部尿道损伤患者尿道狭窄的疗效观察  

Effect of improved urethral irrigation on urethral stricture in patients with closed bulbar urethral injury

作　　者：张旭辉[1] 刘凡 秦琪琪 原小斌[1] 张涛[1] Zhang Xuhui;Liu Fan;Qin Qiqi;Yuan Xiaobin;Zhang Tao(Department of Urology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院泌尿外科,太原030001

出　　处：《中国医师进修杂志》2020年第5期385-388,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨改良尿道冲洗降低闭合性球部尿道损伤患者尿道狭窄的疗效。方法回顾性分析2014年1月至2018年1月山西医科大学第一医院65例男性闭合性球部尿道损伤合并留置尿管困难患者的临床资料。其中,行软膀胱镜下导丝法留置导尿及尿道外口护理30例(常规组),行软膀胱镜下导丝法留置尿管及尿道药物冲洗35例(改良组),比较两组拔除尿管后1和6个月尿道狭窄发生率,拔除尿管后6个月扩尿道次数、最大尿流率,留置尿管期间疼痛视觉模拟评分(VAS)。结果两组患者均成功留置尿管。留置尿管期间,改良组尿道外口分泌物量少而稀薄,常规组尿道外口分泌物量多而黏稠。两组拔除尿管后1个月尿道狭窄发生率和留置尿管期间VAS比较差异无统计学意义(P>0.05);改良组拔除尿管后6个月尿道狭窄发生率和扩尿道次数明显小于常规组[5.7%(2/35)比26.7%(8/30)和(7.1±1.0)次比(11.4±1.8)次],拔除尿管后6个月最大尿流率明显大于常规组[(19.8±2.9)ml/s比(16.3±2.3)ml/s],差异有统计学意义(P<0.05或<0.01)。结论改良尿道冲洗取材方便,制作容易,有利于尿道分泌物的排出,减轻尿道炎性反应,减少尿道瘢痕形成,降低球部尿道狭窄的发生率。Objective To explore the effect of improved urethral irrigation on urethral stricture in patients with closed bulbar urethral injury.Methods The clinical data of 65 male patients with closed bulbar urethral injury complicated with difficult catheterization from January 2014 to January 2018 in the First Hospital of Shanxi Medical University were retrospectively analyzed.Among them,30 cases were treated with flexible cystoscope-guided catheterization and external urethral orifice nursing(routine group),and 35 cases were treated with flexible cystoscope-guided catheterization and urethral drug flushing(improved group).The incidence of urethral stricture 1 and 6 months after catheter removal,number of urethral dilatation and maximum urinary flow rate 6 months after catheter removal,visual analogue score(VAS)during indwelling catheter were compared between 2 groups.Results Both groups indwelled the catheters successfully.During indwelling catheter,the inflammatory secretion in improved group was less and thinner than that in routine group.There was no significant difference in the incidence of urethral stricture 1 month after catheter removal and VAS during indwelling catheter between 2 groups(P>0.05);the incidence of urethral stricture and number of urethral dilatation 6 months after catheter removal in improved group were significantly lower than those in routine group:5.7%(2/35)vs.26.7%(8/30)and(7.1±1.0)times vs.(11.4±1.8)times,the maximum urinary flow rate 6 months after catheter removal was significantly higher than that in routine group:(19.8±2.9)ml/s vs.(16.3±2.3)ml/s,and there were statistical differences(P<0.05 or<0.01).Conclusions The system of improved urethral irrigation can be easily fabricated and can achieve convenient application.This improved treatment can facilitate the discharge of urethral secretions,alleviate the urethral inflammation,reduce the urethral scar formation,and can prevent the incidence of bulbar urethral stricture effectively.

关 键 词：尿道疾病 创伤和损伤 尿道狭窄 尿道冲洗 

分 类 号：R6[医药卫生—外科学]