分期手术在复杂性长段尿道狭窄中的应用:单中心经验  

Application of staged surgery in complex long-segment urethral stricture:a single-center experience

作　　者：徐艳[1] 段刘剑[1] 曹建伟 张林[1] 崔心刚 李超[1] Xu Yan;Duan Liujian;Cao Jianwei;Zhang Lin;Cui Xingang;Li Chao(Department of Urology,Xinhua Hospital Afiliated to Shanghai Jiao Tong University,School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院泌尿外科,上海200092

出　　处：《泌尿外科杂志（电子版）》2024年第4期23-26,共4页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的探讨分期手术在治疗复杂性长段前尿道狭窄中应用效果。方法回顾性分析2017年10月至2022年11月于上海交通大学医学院附属新华医院收治的6例行分期手术尿道重建的复杂性长段尿道狭窄患者的临床资料。结果本组6例患者年龄51(43~71)岁;尿道狭窄长度7.5(7~15)cm,均行分期手术重建尿道。一期手术劈开狭窄段尿道,切除僵硬瘢痕,手术时间76(63~92)min,术后留置导尿管时间5(7~10)d;半年后尿道劈开处上皮化完成,二期行原位卷管重建尿道,二期手术时间81(72~119)min,术中出血量31(5~90)ml,住院时间7(6~10)d,术后留置导尿管16(12~21)d。术后随访22(6~34)个月。1例患者术后发生再狭窄,定期扩张后,仍排尿不畅,重新行膀胱造瘘,其余5例患者皆排尿通畅,术后最大尿流率18.7(16.9~26.4)ml/s,较术前最大尿流率5(0~7)ml/s明显增加,且无相关并发症发生。结论分期手术是复杂性长段尿道狭窄可选择的安全有效的治疗方式,手术效果确切,可根据患者自身条件及术者的自身技术掌握情况,进行合理选择应用。Objective To explore the application of staged surgery in the treatment of complex long segment anterior urethral strictures.Methods The clinical data of six patients with complicated longsegment urethral strictures who underwent staged surgical urethral reconstruction at Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from October 2017 to November 2022were retrospective reviewed.Results Of the 6 patients,patient age was 51(43-71)years;the length of the urethral stricture was 7.5(7-15)cm.Both underwent staged surgical reconstruction of the urethra.The first-stage surgery was to split the stricture section of the urethra and remove the stiff scar,and operation time was 76(63-92)min,time of indwelling catheter was 5(7-10)d.Epithelialization of the urethral cleave was completed after half a year,and the second stage of urethral reconstruction was performed with in situ reel.The second stage operation time was 81(72-119)min,intraoperative blood loss was 31(5-90)ml,hospitalization time was 7(6-10)days,and postoperative indwelling catheter was 16(12—21)days.The follow-up was 22(6-34)months.One patient experienced postoperative restenosis,regular dilation,still poor urination,and new cystostomy.All the remaining 5 patients had smooth urination,and the maximum postoperative urinary flow rate of 18.7(16.9-26.4)ml/s,which significantly increased compared with the preoperative maximum urinary flow rate of 5(0-7)ml/s,and no related complications occurred.Conclusion Staged surgery is a safe and effective treatment option for complex long-segment urethral strictures.The surgical outcomes are precise and can be chosen and applied based on the patient's individual condition and the surgeon's technical proficiency.

关 键 词：尿道狭窄 尿道重建术 尿道板 分期手术 

分 类 号：R699.6[医药卫生—泌尿科学]