3D打印联合超声术中导航在球膜部尿道狭窄诊疗中的应用  

Application of 3D printing combined with intraoperative ultrasound navigation in the diagnosis and treatment of urethral strictures in the bulbar and membranous regions

作　　者：郝云武 卢友路 范欣欢 陈德钢 Hao Yunwu;Lu Youlu;Fan Xinhuan;Chen Degang(Department of Urology,Lu'an Hospital Affiliated of Anhui Medical University,Lu'an 237006,Anhui,China)

机构地区：[1]安徽医科大学附属六安医院,安徽省六安市人民医院泌尿外科,安徽六安237006

出　　处：《中国男科学杂志》2024年第5期58-62,共5页Chinese Journal of Andrology

基　　金：安徽省六安市科技计划项目(2023lakj)。

摘　　要：目的探讨3D打印联合超声术中导航在男性球膜部尿道狭窄临床诊疗中的作用。方法回顾性分析2022年8月至2023年12月本院收治的16例男性球部与膜部尿道狭窄患者的临床资料。年龄53~74岁,平均(60.0±5.1)岁。其中球部狭窄9例,膜部狭窄7例。尿道狭窄的病因:骑跨伤6例,医源性损伤3例,骨盆骨折7例。尿道狭窄病史9个月~8年,平均(35.0±21.9)月;患者既往进行经尿道直视下内切开或扩张术4~38次,平均(8.4±2.6)次;术前进行尿道镜、尿道造影及尿道3D打印进行评估狭窄段尿道,尿道狭窄段长度2.0~3.2 cm,平均(2.6±0.3)cm。所有患者均在入院前1月行耻骨上膀胱造瘘术,均给予经会阴尿道端端吻合术。结果所有患者术前3D尿道打印均能够明确诊断尿道狭窄部位、程度及长度等情况,与术中所见情况一致。16例患者均顺利完成手术,手术时间为72~139 min,平均(92±16.7)min。围手术期均无尿道直肠瘘及尿道皮肤瘘发生,无输血病例。其中1例切口感染,切口分泌物较多,给予挤压切口清除切口下分泌物,同时加强换药2周后切口愈合。所有患者术后3~4周拔除尿管,其中1例球部尿道狭窄患者拔出尿管后出现尿道外口狭窄,给予尿道扩张3次后排尿通畅。随访4~17个月,平均(9.5±3.6)个月。所有患者均排尿通畅,最大尿流率18.3~31.6 mL/s,平均(22.9±3.1)mL/s。尿道造影或膀胱镜检查示尿道管腔通畅。结论3D打印联合超声术中导航在男性球膜部尿道狭窄患者诊疗方面具有重要价值;术前尿道3D打印可精准诊断尿道狭窄位置、程度及长度等;术中超声导航明确尿道狭窄的近端位置以及与直肠之间的关系,有利于快速清除尿道狭窄近端周围瘢痕组织,同时有效避免直肠损伤等严重并发症的发生。Objective To explore the application of 3D printing combined with intraoperative ultrasound navigation in the clinical diagnosis and treatment of male urethral stricture in the bulbar region.Methods A retrospective analysis was conducted on the clinical data of 16 male patients with bulbar and membranous urethral strictures admitted to our hospital from August 2022 to December 2023.Age range of the patients was from 53 to 74 years old,with an average of(60±5.1)years old.Among them,there were 9 cases of bulbar stenosis and 7 cases of membranous stenosis.The causes of urethral stricture covered straddle injury(6 cases),iatrogenic injury(3 cases),and pelvic fracture(7 cases).A history of urethral stricture ranged from 9 months to 8 years,with an average of(35±21.9)months;The patient underwent a total of 4~38 transurethral incisions or expansions under direct vision,with an average of(8.4±2.6)times;Before surgery,urethral endoscopy,urethral imaging,and urethral 3D printing were performed to evaluate the stenotic segment of the urethra.The length of the urethral stenotic segment was 2.0~3.2 cm,with an average of(2.6±0.3)cm.All patients underwent suprapubic cystostomy one month prior to admission and received transperineal urethral end-to-end anastomosis.Results The location,degree,and length of urethral stricture of the patients were clearly defined using preoperative 3D urethral printing,in agreement with the intraoperative findings.All the patients underwent surgery successfully,with a surgical time of 72~139 minutes and an average of(92±16.7)minutes.There were no occurrences of urethral rectal fistula or urethral skin fistula during the perioperative period,and no cases of blood transfusion.One case had incision infection with a significant amount of secretion,which was treated with compression to remove the secretions below the incision,and the wound was healed after 2 weeks of dressing change.All patients'urinary catheters were removed 3~4 weeks after surgery.Among them,one patient with bulbous urethral stri

关 键 词：3D打印 超声检查 端端吻合术 尿道狭窄 

分 类 号：R695.4[医药卫生—泌尿科学] R699.6[医药卫生—外科学]