非离断尿道成形术治疗球部尿道狭窄的疗效分析  

The efficacy of non-transecting uerthroplasty in the management of bulbar urethral stricture

作　　者：谢弘[1] 杨涛[1] 罗志强 宋鲁杰[1] 张炯[1] 金重睿[1] 胡晓勇[1] 傅强[1] Xie Hong;Yang Tao;Luo Zhiqiang;Song Lujie;Zhang Jiong;Jin Chongrui;Hu Xiaoyong;Fu Qiang(Department of Urology,Shanghai Jiaotong University Affiliated Sixth People’s Hospital,Shanghai Eastern Urological Reconstruction and Repair Institute,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海东方泌尿修复重建研究所,200233

出　　处：《中华泌尿外科杂志》2021年第8期609-614,共6页Chinese Journal of Urology

摘　　要：目的:比较非离断尿道成形术(NTU)与尿道端端吻合术(EPA)治疗球部尿道狭窄的效果。方法:回顾性分析2016年1月至2019年12月上海市第六人民医院收治的73例球部尿道狭窄患者的病例资料。患者年龄18~60岁,均为球部尿道狭窄,狭窄长度<2 cm,既往无尿道手术史,无多段尿道狭窄,术前不存在明显勃起功能障碍。根据手术方式将患者分为NTU组25例和EPA组48例。NTU组和EPA组的年龄分别为(39.2±9.4)岁和(42.1±9.3)岁,病程分别为6.0(3.0~14.0)个月和6.5(3.0~11.0)个月,体质指数分别为(23.7±3.2)kg/m 2和(24.5±2.7)kg/m 2,术前最大尿流率(Q max)分别为(8.7±4.3)ml/s和(7.9±4.6)ml/s,狭窄段长度分别为(1.7±0.4)cm和(1.8±0.2)cm,术前国际勃起功能问卷(IIEF-5)分别为(20.9±1.9)分和(21.3±2.1)分,差异均无统计学意义(P>0.05)。NTU组和EPA组的病因分别为外伤8例(32.0%)和31例(64.6%)、医源性损伤11例(44.0%)和9例(18.8%)、其他6例(24.0%)和8例(16.7%),差异有统计学意义(P=0.023)。所有手术均由同一组医生完成,术中评估尿道瘢痕情况,若不离断尿道情况下能彻底切除瘢痕组织则行NTU,在狭窄段尿道远心端背侧切开,横向楔形切除尿道瘢痕,间断缝合尿道;否则行EPA,完全游离切断尿道,彻底切除狭窄段尿道及周围瘢痕组织,行尿道端端吻合术。记录手术时间、术中出血情况。术后排尿困难,尿道镜检及尿道造影检查提示手术部位尿道狭窄定义为手术失败。术后3周拔除导尿管,术后3周、6个月、12个月测量尿流率,术后12个月评估勃起功能,术后1~2年行尿道造影检查。结果:本研究73例手术均顺利完成。NTU组和EPA组的手术时间分别为(67.6±11.3)min和(62.7±10.1)min,差异无统计学意义(P=0.063);术中出血量分别为(71.6±16.2)ml和(86.0±20.8)ml,差异有统计学意义(P=0.004)。术后中位随访时间18.0(13~38)个月,NTU组和EPA组手术成功率分别为92.0%(23/25)和93.8%(45/48)。NTU组和EPA�Objective To compare efficacy and erectile function outcome of Non-transecting Urethroplasty(NTU)with excision and primary anastomotic urethroplasty(EPA)in the management of bulbar urethral stricture.Method A retrospective analysis of the case data of 73 patients with bulbar urethral stricture admitted to Shanghai Sixth People's Hospital from January 2016 to December 2019.The patients are 18 to 60 years old,because of the stenosis of the bulbous urethra,the length of the stenosis is less than 2 cm,and there is no history of urethral surgery,no multiple urethral stricture,and no obvious ED before surgery.According to the operation method,the patients were divided into 25 cases in NTU group and 48 cases in EPA group.The ages of the NTU group and the EPA group were(39.2±9.4)years and(42.1±9.3)years,respectively.The course of the disease was 6.0(3.0-14.0)months and 6.5(3.0-11.0)months,respectively,and the body mass index was(23.7±3.2)kg/m2 and(24.5±2.7)kg/m2,the preoperative maximum urine flow rate(Qmax)was(8.7±4.3)ml/s and(7.9±4.6)ml/s,respectively,and the length of the stenosis was respectively(1.7±0.4)cm and(1.8±0.2)cm,the preoperative International Erectile Function Questionnaire(IIEF-5)was(20.9±1.9)points and(21.3±2.1)points,respectively,the difference was not statistically significant(P>0.05).The etiology of NTU group and EPA group were 8 cases(32.0%)and 31 cases(64.6%)of trauma,11 cases(44.0%)and 9 cases(18.8%)of iatrogenic injury,and 6 cases(24.0%)and 8 cases(16.7%),the difference was statistically significant(P=0.023).All operations were performed by the same team of doctors.The urethral scar was assessed during the operation.If the scar tissue can be completely removed without breaking the urethra,NTU is performed.The distal end of the urethra is cut at the dorsal side of the narrow segment of the urethra,and the urethral scar is removed in a transverse wedge shape.The urethra is sutured;otherwise,EPA is performed,the urethra is completely cut off,the stricture of the urethra and surrounding scar

关 键 词：尿道狭窄 球部尿道狭窄 非离断尿道海绵体 勃起功能 

分 类 号：R699.6[医药卫生—泌尿科学]