阴茎远端尿道狭窄疾病的手术治疗方式  

Surgical management of the distal urethral stricture diseases

作　　者：王杰 王建伟 夏海缀 徐啸 翟建坡 何峰 黄广林 李贵忠 WANG Jie;WANG Jianwei;XIA Haizhui;XU Xiao;ZHAI Jianpo;HE Feng;HUANG Guanglin;LI Guizhong(Department of Urology,Beijing Jishuitan Hospital,Capital Medical Universitay,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院泌尿外科,北京100035

出　　处：《北京大学学报（医学版）》2024年第6期1075-1082,共8页Journal of Peking University:Health Sciences

摘　　要：目的:探讨阴茎远端尿道狭窄疾病的手术治疗方式。方法:回顾性收集自2018年1月至2022年12月就诊于首都医科大学附属北京积水潭医院的80例阴茎远端尿道狭窄患者的临床资料,包括男性生殖器苔藓样硬化(male genital lichen sclerosus,MGLS)33例,医源性损伤25例,尿道下裂术后12例,外伤等其他原因10例。狭窄仅累及尿道外口54例,其中38例行尿道外口切开术(meatotomy,MO),7例行阴茎皮瓣尿道成形术(penile skin flap urethroplasty,PSFU),9例行口腔黏膜尿道成形术(oral mucosa graft urethroplasty,OMGU);狭窄同时累及尿道外口和舟状窝26例,其中1例行PSFU,25例行OMGU。以术式不同将80例患者分为MO、PSFU、OMGU 3组,平均年龄分别为(48.8±20.0)岁、(53.3±21.8)岁、(44.5±16.4)岁;平均体重指数(body mass index,BMI)分别为(28.6±3.9)kg/m^(2)、(29.6±3.2)kg/m^(2)、(29.2±4.8)kg/m^(2);平均术前最大尿流率分别为(5.8±2.3)mL/s、(6.8±2.4)mL/s、(5.7±3.1)mL/s。结果:所有手术均顺利完成,围术期无ClavienⅢ或Ⅳ级并发症发生。3组中位狭窄长度(术中测量)分别为1.1(1.0,1.6)、1.5(1.1,2.0)、4.0(2.5,5.0)cm;中位手术时间分别为60.0(60.0,75.0)、85.0(75.0,112.5)、180.0(75.0,330.0)min;中位估计出血量分别为5.0(2.0,10.0)、15.0(5.0,42.5)、180.0(135.0,216.3)mL;术后中位住院日分别为3.5(2.0,5.0)、6.5(3.5,7.0)、7.5(7.0,11.3)d;术后中位随访时间分别为40.0(26.3,57.3)、55.0(18.8,62.8)、52.5(30.5,64.0)个月;术后中位最大尿流率分别为18.3(15.5,19.8)、19.2(16.1,20.1)、17.2(14.2,19.6)mL/s。38例MO中33例排尿通畅,无需干预;5例狭窄复发,需定期尿道扩张。8例PSFU中7例排尿通畅,无需干预;1例出现尿瘘,建议干预,但患者决定维持现状。34例OMGU中28例排尿通畅,无需干预;6例狭窄复发,其中5例需定期尿道扩张,1例再行重建手术。所有病例术后成功率为85.0%,再干预率为15.0%。统计分析发现,3组患者的狭窄病因(P=0.002)、狭窄部位(PObjective:To evaluate the surgical methods for treating distal urethral stricture.Methods:The clinical data of 80 patients with distal urethral stricture in Beijing Jishuitan Hospital,Captial Medical University between January 2018 and December 2022 were retrospectively collected.Including male genital lichen sclerosus(MGLS)33 cases,iatrogenic injury 25 cases,postoperative hypospadias 12 cases,and other causes such as trauma 10 cases.Among these cases,strictures involved the urethral meatus in 54 instances,of which 38 were treated with meatotomy(MO),7 with penile skin flap urethroplasty(PSFU),and 9 with oral mucosa graft urethroplasty(OMGU).There were also 26 instances where strictures involved both the navicular fossa and meatus;one case underwent PSFU while 25 underwent OMGU.Based on different surgical methods used for treatment purposes we divided the patients into MO group,PSFU group and OMGU group.The age of the three groups was(48.8±20.0)years,(53.3±21.8)years and(44.5±16.4)years.The mean±SD body mass index(BMI)was(28.6±3.9)kg/m^(2),(29.6±3.2)kg/m^(2) and(29.2±4.8)kg/m^(2).The preoperative maximum flow rate was(5.8±2.3)mL/s,(6.8±2.4)mL/s and(5.7±3.1)mL/s.Results:All the operations were successfully completed without ClavienⅢorⅣcomplications.The median length of strictures(measured intraoperatively)in the three groups were 1.1(1.0,1.6),1.5(1.1,2.0)and 4.0(2.5,5.0)cm.The median operation time was 60.0(60.0,75.0),85.0(75.0,112.5)and 180.0(75.0,330.0)min.The median estimated blood loss was 5.0(2.0,10.0),15.0(5.0,42.5)and 180.0(135.0,216.3)mL.The median postoperative hospital stay was 3.5(2.0,5.0),6.5(3.5,7.0)and 7.5(7.0,11.3)days.The median follow-up duration was 40.0(26.3,57.3),55.0(18.8,62.8)and 52.5(30.5,64.0)months.The median postoperative maximum flow rate was 18.3(15.5,19.8),19.2(16.1,20.1)and 17.2(14.2,19.6)mL/s.Among the 38 patients with MO,33 cases had normal urination without reintervention,and 5 cases experienced recurrent strictures and required regular urethral dilation.Among the 8 pa

关 键 词：尿道外口 舟状窝 阴茎皮瓣 口腔黏膜 尿道成形术 

分 类 号：R697.1[医药卫生—泌尿科学]