直视下尿道内切开术的再认识

目的：观察直视下尿道内切开术（DVIU）的长期疗效,重新评价DVIU的临床应用价值。方法：回顾性分析2003年1月～2007年1月收治的65例尿道狭窄或闭锁患者行DVIU及术后随访的临床资料：狭窄长度0．5～2．0cm,平均1．2cm。其中≤1．0cm者25例,1．1～2．0cm者40例。30例行尿道超声检查测量尿道瘢痕厚度,其中瘢痕厚度≤1cm者10例,〉1cm者20例,瘢痕长度和厚度均≤1cm者9例。结果：65例共行DVIU72例次,72例次内切开手术均获得成功。63例获得随访,随访时间24～60个月,平均40．5个月。48例（76．2％）因狭窄复发而最终接受开放手术。尿道超声显示瘢痕厚度≤1cm的10例中,只有1例接受手术;瘢痕厚度〉1cm的20例中,18例接受手术;瘢痕长度和厚度均≤1cm的9例均未行手术。结论：DVIU适合于狭窄段和瘢痕厚度均〈1cm的患者,切开次数以1次为宜,手术疗效与严格掌握适应证密切相关。     

超长段尿道狭窄术后勃起功能的评估

Objective To investigate the effect of substitutive reconstruction of long urethral stricture on male erectile function. Methods From January 2007 to January 2009, 23 patients with anterior or posterior long urethral stricture were accepted for a variety of onlay substitutive procedures, including lingual mucosa, perputial skin, and mid-scrotal skin. During the follow-up, data from the International Index of Erectile Function-5 (ⅡEF-5) questionnaire and the Quality of Life (QOL) questionnaire as well as maximal flow rate were recorded. All data were compared with those obtained before surgery. Results Significant improvement in QOL (1.22 ± 1.40, 1.82 ± 1. 17,2.07± 0.46) and maximal flow rate (22.46± 4.65, 23.81 ± 6.22, 21.52 ±7.44 ) could be observed 3, 6 and 12 months after surgery compared with those before surgery (5. 22 ± 0. 75, 3. 93 ± 3. 62)(P＜0.01). No significant differences in the responses to the ⅡEF-5 questionnaire were observed among all patients during the follow-up (P＞0. 05). At the 3, 6 and 12 months after procedure,scores of ⅡEF-5 in patients with anterior urethral stricture ( 17.79 ± 6.42, 16. 57 ± 4. 78, 16.01 ±3.85) were significantly higher than those with posterior urethral stricture (11.67 ± 2.59, 12.35 ±1.83,13. 19±1.67, P＜0.05). In patients with posterior urethral stricture, the multiple linear regression showed that age, time interval of injury and length of stricture were related to the ⅡEF-5score (P＜0.05). Conclusions Substitutive reconstruction for treating the long urethral stricture has little effect on male erectile function. But the location of stricture, especially extended to posterior urethra, may have impact on the erectile function.     

超长段尿道狭窄术后勃起功能的评估

Objective To investigate the effect of substitutive reconstruction of long urethral stricture on male erectile function. Methods From January 2007 to January 2009, 23 patients with anterior or posterior long urethral stricture were accepted for a variety of onlay substitutive procedures, including lingual mucosa, perputial skin, and mid-scrotal skin. During the follow-up, data from the International Index of Erectile Function-5 (ⅡEF-5) questionnaire and the Quality of Life (QOL) questionnaire as well as maximal flow rate were recorded. All data were compared with those obtained before surgery. Results Significant improvement in QOL (1.22 ± 1.40, 1.82 ± 1. 17,2.07± 0.46) and maximal flow rate (22.46± 4.65, 23.81 ± 6.22, 21.52 ±7.44 ) could be observed 3, 6 and 12 months after surgery compared with those before surgery (5. 22 ± 0. 75, 3. 93 ± 3. 62)(P＜0.01). No significant differences in the responses to the ⅡEF-5 questionnaire were observed among all patients during the follow-up (P＞0. 05). At the 3, 6 and 12 months after procedure,scores of ⅡEF-5 in patients with anterior urethral stricture ( 17.79 ± 6.42, 16. 57 ± 4. 78, 16.01 ±3.85) were significantly higher than those with posterior urethral stricture (11.67 ± 2.59, 12.35 ±1.83,13. 19±1.67, P＜0.05). In patients with posterior urethral stricture, the multiple linear regression showed that age, time interval of injury and length of stricture were related to the ⅡEF-5score (P＜0.05). Conclusions Substitutive reconstruction for treating the long urethral stricture has little effect on male erectile function. But the location of stricture, especially extended to posterior urethra, may have impact on the erectile function.     

小肠黏膜下脱细胞基质修复前尿道狭窄的疗效分析

目的 探讨小肠黏膜下脱细胞基质(small intestinal submucosa,SIS)修复前尿道狭窄的可行性和有效性.方法 2009年6月至2010年8月采用4层SIS补片修复治疗尿道狭窄患者18例.患者年龄20～69岁,平均38岁;尿道狭窄段3.5～7.0 cm,平均4.6 cm;术前最大尿流率1.5～5.5 ml/s,平均3.8 ml/s.术中按需将SIS(长4.0～7.5 cm,宽 2.0 cm)植入尿道背侧缺损处,5-0可吸收线将SIS间断固定在阴茎海绵体上,SIS两侧与已剪开的狭窄段尿道作连续缝合,两端分别与尿道断端作间断吻合.结果 手术过程顺利,术后恢复好.随访6～18个月,平均10个月,患者未发生感染、排斥反应等并发症.17例排尿通畅,最大尿流率14.0～44.0 ml/s,平均25.4 ml/s.尿道造影显示尿道通畅;术后4、6周尿道镜检查示SIS移植物与周围组织分界清楚;术后14周尿道镜检查SIS已降解,修复段尿道与周围组织间限消失,黏膜光洁完整,管腔无明显狭窄;植入SIS部位活检显示黏膜表层为上皮细胞.1例尿道下裂术后患者术后5个月出现轻度尿道狭窄症状,行尿道扩张治疗.结论 利用SIS修复尿道狭窄具有创伤小、抗感染力强的特点,可作为组织工程尿道修复重建材料修复部分尿道狭窄患者.

Abstract：

Objective To investigate the feasibility of using small intestinal submucosa (SIS) graft for the repair of anterior urethral strictures. Methods From June 2009 to August 2010, 18 men (mean age, 38 yrs) with anterior urethral strictures underwent urethroplasty using a four-layer SIS as an onlay patch graft. SIS was used to augment the urethral caliber at the stricture site. The mean stricture length was 4.6 cm (range 3.5 to 7 cm). The pre-operative mean maximal flow rate was 3.8 ml/s (range 1.5 to 5.5 ml/s). The required SIS grafts (4 to 7.5 cm long and 2 cm wide) were positioned into the urethrotomy defect and were spread-fixed to the corpora cavernosa using 5-0 polyglactin interrupted sutures. Two apices of the graft were sutured to the proximal and distal apices of the urethrotomy with 5-0 polyglactin interrupted stitches. The margins of the opened urethra were sutured to the SIS patch with 5-0 polyglactin running sutures. Results The mean follow-up period was 10 mon. (range 6-18 mon.). No postoperative complication, such as infection or rejection related to the use of heterologous graft material was observed. Seventeen patients voided well postoperatively with the mean peak urine flow of 25.4 ml/s (14-44 ml/s). Cystoscopy revealed that at four weeks and six weeks, the SIS graft was well distinguishable from the normal surrounding tissue; and at 16 weeks, the urothelium was regenerated and the biomaterial was not distinguishable from the normal surrounding tissue. The squamosal epithelium was seen in the histological examination of the grafts. The remaining one patient with failed hypospadias developed a slight urethral narrowing at five months post-operatively and needed sound dilatations. Conclusions SIS matrix appears to be a safe and effective reconstructive material in selected urethral reconstructions.     

超长段尿道狭窄术后勃起功能的评估

目的 探讨自体组织替代治疗超长段尿道狭窄对勃起功能的影响.方法 回顾性分析2007年1月至2009年1月采用不同自体组织补片(阴囊纵隔、包皮内板、口腔黏膜)Onlay术式替代治疗超长段男性尿道狭窄患者的临床资料,并随访患者ⅡEF-5评分、QOL评分及最大尿流率,并与术前相应情况进行分析.结果 根据研究标准收集23份有效数据.患者术前及术后3、6、12个月QOL评分分别为5.22±0.75、1.22±1.40、1.82±1.17、2.07±0.46,最大尿流率分别为(3.93±3.62)、(22.46±4.65)、(23.81±6.22)、(21.52±7.44)ml/s,术后不同时期均较术前明显改善(P＜0.01).术前及术后3、6、12个月ⅡEF-5评分分别为14.47±9.55、14.70±5.32、14.26±3.29和14.58±3.62,组间比较差异无统计学意义(P＞0.05).9例狭窄部位累及至后尿道者术后3、6、12个月ⅡEF-5评分分别为11.67±2.59、12.35±1.83、13.19±1.67,14例单纯前尿道狭窄者分别为17.79±6.42、16.57±4.78、16.01±3.85,2组间比较差异均有统计学意义(P＜0.05).狭窄累及后尿道患者多元线性回归分析中,年龄、受伤时间及尿道狭窄段长度与替代术后ⅡEF-5评分呈多元线性相关.结论 自体组织替代治疗男性超长段尿道狭窄对勃起功能影响不明显;狭窄段累及后尿道时可能对患者勃起功能产生一定影响.患者年龄和受伤时间对勃起功能有协同影响作用.

Abstract：

Objective To investigate the effect of substitutive reconstruction of long urethral stricture on male erectile function. Methods From January 2007 to January 2009, 23 patients with anterior or posterior long urethral stricture were accepted for a variety of onlay substitutive procedures, including lingual mucosa, perputial skin, and mid-scrotal skin. During the follow-up, data from the International Index of Erectile Function-5 (ⅡEF-5) questionnaire and the Quality of Life (QOL) questionnaire as well as maximal flow rate were recorded. All data were compared with those obtained before surgery. Results Significant improvement in QOL (1.22 ± 1.40, 1.82 ± 1. 17,2.07± 0.46) and maximal flow rate (22.46± 4.65, 23.81 ± 6.22, 21.52 ±7.44 ) could be observed 3, 6 and 12 months after surgery compared with those before surgery (5. 22 ± 0. 75, 3. 93 ± 3. 62)(P＜0.01). No significant differences in the responses to the ⅡEF-5 questionnaire were observed among all patients during the follow-up (P＞0. 05). At the 3, 6 and 12 months after procedure,scores of ⅡEF-5 in patients with anterior urethral stricture ( 17.79 ± 6.42, 16. 57 ± 4. 78, 16.01 ±3.85) were significantly higher than those with posterior urethral stricture (11.67 ± 2.59, 12.35 ±1.83,13. 19±1.67, P＜0.05). In patients with posterior urethral stricture, the multiple linear regression showed that age, time interval of injury and length of stricture were related to the ⅡEF-5score (P＜0.05). Conclusions Substitutive reconstruction for treating the long urethral stricture has little effect on male erectile function. But the location of stricture, especially extended to posterior urethra, may have impact on the erectile function.     

Short-term efficacy of laparoscopy-assisted vs open radical gastrectomy in gastric cancer

AIM:To investigate the short-term benefits of laparoscopic radical gastrectomy(LARG)and open radical gastrectomy(ORG)in patients with gastric cancer.METHODS:A total of 400 patients with gastric cancer aged≤65 years who were treated at General Hospital of Lanzhou Military Region were enrolled.Among these,200 patients underwent LARG between October2008 and August 2012(LARG group);and 200 patients underwent ORG between March 2000 and September2008(ORG group).The short-term therapeutic benefits between the two groups were analyzed.RESULTS:The LARG procedure offered significantly better benefits to the patients compared to the ORG procedure,including less intraoperative blood loss(103.1±19.5 mL vs 163.0±32.9 mL,P0.0001),shorter postoperative hospital stay(6.8±1.2 d vs 9.5±1.6 d,P0.0001),less frequent occurrence of postoperative complications(6.5%vs 13.5%,P=0.02),shorter time to mobilization(1.0±0.3 vs 3.3±0.4 d,P0.0001),shorter time to bowel opening(3.3±0.7 d vs 4.5±0.7 d,P0.0001),and shorter time to normal diet(3.0±0.4 vs d 3.8±0.5 d,P0.0001).However,LARG required a longer time to complete than the ORG procedure(192.3±20.9 min vs 180.0±26.9 min,P0.0001).CONCLUSION:Compared to ORG,LARG is safer,more effective,and less invasive for treating gastric cancer,with better short-term efficacy.     

前列腺按摩尿道加压灌药加体外高频热疗治疗慢性前列腺炎的临床研究

Objectives To evaluate the effects of combined therapy for chronic bacterial prostatitis. Methods A total of 226 patients with chronic bacterial prostatitis were randomly divided into 2 groups. Group A:transurethral perfusion combined with external high frequency thermotherapy. Group B: Combination therapy of antibiotherapy and Prostat. The treatment course for each group was 2 months.The therapeutic effects of the 2 therapies were compared and analyzed. Results The arerage CPSI scores in group A and B were reduced by 15.1、12.1 respectively; the rates of the patients( EPS＜10/HP) in each group were 76% and 70% respectively; the bacterium negative rates in Group A and B were 76.9% and 65.2% respectively. Conclusions The curative effect of transurethral perfusion combined with external high frequency thermotherapy was better than that of Combination therapy of antibiotherapy and Prostat.     

超声引导下肢神经阻滞联合喉罩下全麻用于全膝关节置换术的效果

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.     

超声引导下肢神经阻滞联合喉罩下全麻用于全膝关节置换术的效果

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.     

Operative techniques of anastomotic posterior urethroplasty for traumatic posterior urethral strictures

Objective： To elucidate the details of operative technique of anastomotic posterior urethroplasty for traumatic posterior urethral strictures in attempt to offer a successful result. Methods： We reviewed the clinical data of 106 patients who had undergone anastomotic repair for posterior urethral strictures following traumatic pelvic fracture between 1979 and 2004. Patients＇ age ranged from 8 to 53 years （mean 27 years ）. Surgical repair was performed via perinea in 72 patients, modified transperineal repair in 5 and perineoabdominal repair in 29. Follow-up ranged from 1 to 23 years （ mean 8 years ）. Results： Among the 77 patients treated by perineal approaches, 69 （95.8 % ） were successfully repaired and 27 out of the 29 patients （93. 1% ） who were repaired by perineoabdominal protocols were successful. The successful results have sustained as long as 23 years in some cases.Urinary incontinence did not happen in any patients while impotence occurred as a result of the anastomotic surgery. Conclusions： Three important skills or principles will ensure a successful outcome, namely complete excision of scar tissues, a completely normal mucnsa ready for anastomosis at both ends of the urethra, and a tension-free anastomosis. When the urethral stricture is below 2. 5 cm long, restoration of urethral continuity can be accomplished by a perineal procedure. If the stricture is over 2. 5 cm long, a modified perineal or transpubic perineoabdominal procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely （5.7 % ） to urethroplasty.     

尿道背侧颊黏膜镶嵌补片法治疗长段前尿道狭窄

目的 评价颊黏膜尿道背侧镶嵌技术尿道修复重建手术的有效性和安全性.方法 男性前尿道狭窄患者57例.平均年龄36(17～52)岁.尿道狭窄长度平均3.0(2.5～7.0)cm.颊黏膜取材长度平均4.0(3.5～8.0)cm,平均宽度2.3(I.8～2.5)am.57例均有经尿道内窥镜冷切电切手术史,其中1次手术史29例(51%),2次20例(35%),3次8例(14%),行耻骨上膀胱造瘘48例,9例采用尿道扩张维持.手术游离并旋转尿道,并于尿道背侧纵行切开,6-0可吸收线缝合颊黏膜与尿道切缘.保留尿管4周,拔管时行顺行尿道造影.患者排尿困难和尿线变细、尿道造影或尿道镜发现尿道管腔狭窄<16 F确定为尿道狭窄复发.结果 57例手术均成功,平均手术时间135(105150)min.平均随访11.2(1～23)个月.尿道通畅54例(95%),术后2～3个月复发3例(5%),狭窄部位均为远端的颊黏膜与尿道结合部,行尿道内窥镜冷刀切开,定期尿道扩张治疗.伤口感染3例,未发生尿瘘及尿道憩室.患者口腔疼痛持续2～5 d,平均2.3 d.术后无张VI困难、颊部麻木及腮腺导管梗阻等并发症发生,VI腔颊部均未见瘢痕形成.结论 VI腔颊黏膜尿道背侧镶嵌补片修复重建尿道,效果确切、并发症少、狭窄复发率低,是理想的长段前尿道狭窄的修复重建手段.     

Direct vision internal urethrotomy for the treatment of pediatric urethral strictures: analysis of 50 patients

PURPOSE: In an attempt to evaluate our experience with the treatment of pediatric urethral stricture disease we performed a retrospective review of patients undergoing direct vision internal urethrotomy (DVIU). MATERIALS AND METHODS: The computerized surgical logs at 2 pediatric hospitals were reviewed to identify patients who underwent DVIU between 1992 and 2001. Hospital and clinical charts were then reviewed. Many variables were analyzed, including patient age, etiology of stricture, technique and clinical outcomes. Minimum followup to be included in clinical outcome analysis was 12 months. RESULTS: A total of 50 patients were identified (mean age 7.7 years, range 6 months to 17 years). The most common etiology for stricture formation was previous hypospadias repair (20 patients [40%]). Forty patients met the 12-month minimum followup requirement for clinical outcome analysis. Of these patients 20 (50%) had no symptoms to suggest recurrent stricture at a median of 2.0 years (mean 2.7 years, range 12 months to 7 years). Seventeen patients (42.5%) had symptoms of recurrent stricture at a median of 8 months (mean 13 months, range 2 months to 5 years). Technical factors did not influence the ultimate success or failure of the procedure. CONCLUSIONS: DVIU provides a therapeutic option that successfully treats approximately half of the patients with a reasonably low complication rate. Complications following DVIU should not preclude its use as a therapeutic modality for the treatment urethral strictures in children. If the child fails the initial DVIU, repeat attempts at endoscopic correction of urethral stricture should be abandoned in favor of definitive urethroplasty.     

经尿道前列腺电切术后尿道狭窄的原因分析

目的 分析并探讨经尿道前列腺电切术(TURP)术后尿道狭窄的原因,避免其发生.方法 回顾性分析我院1999年1月至2010年1月收治的23例前列腺电切术后尿道狭窄患者,年龄57~78岁,平均67.8岁;狭窄段尿道长度为1.6~3.5cm(平均2.3cm);最大尿流率为4～14ml/s,平均75ml/s;术后出现狭窄的时间为1个月~17年,平均25个月.其中前尿道狭窄6例,后尿道狭窄15例,膀胱颈口处狭窄2例.对于明确的尿道狭窄患者,针对不同情况分别给予尿道扩张、尿道内冷刀切开、残留前列腺组织切除或瘢痕切除处理.结果 随访3个月~6个月,23例患者中6例前尿道狭窄经定期尿道扩张后症状消失,疗效满意.后尿道狭窄的15例患者,2例采用定期尿道扩张的方法治愈,3例行残留腺体切除后症状逐渐缓解,另外1例因后尿道瘢痕较多,于尿道内行冷刀切开后复发,其余后尿道狭窄患者疗效满意.膀胱颈口处狭窄的2例患者,行膀胱颈口冷刀切开及瘢痕切除后治愈.术后23例患者最大尿流率19~29 ml/s,平均24.4 ml/s.结论 尿道狭窄是TULIP术后常见的并发症,其发生与尿路感染、操作损伤、术后留置尿管过粗、置管时间过长、腺体残留等因素密切相关.     

经尿道钬激光治疗男性尿道狭窄

目的:探讨经尿道钬激光治疗男性尿道狭窄的方法、安全性和疗效。方法:对38例男性尿道狭窄患者行经尿道狭窄段疤痕钬激光切除(功率10~45W),狭窄段长度:<1.0cm者18例,1.0~1.5cm者9例,>1.5cm者7例,完全闭锁者4例,并发膀胱结石者6例。平均最大尿流率为(5.6±2.3)ml/s。结果:36例手术成功,无大出血、尿外渗、直肠损伤等并发症发生,术后平均最大尿流率为(17.5±3.4)ml/s,2例中转开放手术,32例获随访3~18个月,其中4例行定期尿道扩张,2例以钬激光行二次手术后治愈。结论:经尿道钬激光治疗男性尿道狭窄安全、有效、创伤小、可重复治疗。     

Long-term outcome of visual internal urethrotomy for the management of pediatric urethral strictures

PURPOSE: We evaluated the long-term results of visual internal urethrotomy for pediatric urethral strictures to evaluate the efficacy and final outcome of this procedure in children and to evaluate the risk factors for stricture recurrence. MATERIALS AND METHODS: The computerized surgical records of our hospital were reviewed to identify children who underwent visual internal urethrotomy between 1980 and 2001. Hospital and followup clinical charts were then reviewed. Many variables were analyzed, including age, etiology, length and site of the strictures, and catheter duration. Only patients with a minimum followup of 2 years were included. Regular self-catheterization was not used by any child. RESULTS: A total of 31 patients (mean age 11.2 years, range 2 to 18) were identified. Followup ranged from 2 to 20 years, with a mean of 6.6 years. The most common etiology for stricture formation was failed previous urethroplasty and post instrumentation (35.5% and 32.3%, respectively). The success rate after initial urethrotomy was 35.5% (11 of 31 patients). Mean interval to first recurrence was 26 months. A second urethrotomy improved the success rate of 58.1%. Eight patients required 2 or more urethrotomies, of whom half required open urethroplasty. Among the evaluated variables only stricture length shorter than 1 cm was associated with good results. CONCLUSIONS: Visual internal urethrotomy provides a safe first line therapeutic option for pediatric urethral strictures shorter than 1 cm, independent of etiology and location. For patients with more than 1 recurrence or with strictures longer than 1 cm, who are at high risk for recurrence after internal urethrotomy, open urethroplasty remains the treatment of choice.     

后尿道狭窄外科治疗191例临床分析

目的探讨后尿道手术方法的选择及疗效。方法回顾分析1990年1月-2006年1月本院收治的191例后尿道狭窄或闭锁患者的临床资料。术前191例均行尿道造影,62例行尿道超声检查,48例行尿道镜检查,4例行尿道磁共振成像（MRI）检查。26例患者行尿道内切开;165例患者行开放性手术,其中单纯经会阴尿道吻合术66例,经会阴切开阴茎中隔48例,经会阴切除耻骨下缘30例,经耻骨尿道吻合术18例,尿道拖入术3例。术后随访6～48个月,平均26．6个月。结果后尿道狭窄或闭锁长度为1．5～8．0cm,平均3．6cm。后尿道狭窄（尿道连续性尚存）31例（16％）;后尿道完全闭锁160例（84％）,其中闭锁段〈3cm者102例（53．4％）,闭锁段〉3cm者58例（30．6％）。手术总体成功率（最大尿流率〉15ml／s）为84．3％（161／191）,其中尿道内切开为69％（18／26）,开放性手术为86．6％（143／165）。单纯经会阴尿道吻合术、经会阴切开阴茎中隔、经会阴切除耻骨下缘、经耻骨尿道吻合术及尿道拖入术的成功率分别为97％（64／66）、79％（38／48）、80％（24／30）、83％（15／18）和67％（2／3）。后尿道狭窄（尿道连续性尚存）的成功率为94％（29／31）;闭锁段〈3cm的患者为90％（92／102）;闭锁段〉3cm患者为69％（40／58）。结论开放性手术疗效优于尿道内切开,后尿道狭窄或闭锁段〈3cm患者疗效较好。     

Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture

PURPOSE: Treatment for urethral stricture disease often requires a choice between readily available direct vision internal urethrotomy (DVIU) and highly efficacious but more technically complex open urethral reconstruction. Using the short segment bulbous urethral stricture as a model, we determined which strategy is less costly. MATERIALS AND METHODS: The costs of DVIU and open urethral reconstruction with stricture excision and primary anastomosis for a 2 cm bulbous urethral stricture were compared using a cost minimization decision analysis model. Clinical probability estimates for the DVIU treatment arm were the risk of bleeding, urinary tract infection and the risk of stricture recurrence. Estimates for the primary urethral reconstruction strategy were the risk of wound complications, complications of exaggerated lithotomy and the risk of treatment failure. Direct third party payer costs were determined in 2002 United States dollars. RESULTS: The model predicted that treatment with DVIU was more costly (17,747 dollars per patient) than immediate open urethral reconstruction (16,444 dollars per patient). This yielded an incremental cost savings of $1,304 per patient, favoring urethral reconstruction. Sensitivity analysis revealed that primary treatment with urethroplasty was economically advantageous within the range of clinically relevant events. Treatment with DVIU became more favorable when the long-term risk of stricture recurrence after DVIU was less than 60%. CONCLUSIONS: Treatment for short segment bulbous urethral strictures with primary reconstruction is less costly than treatment with DVIU. From a fiscal standpoint urethral reconstruction should be considered over DVIU in the majority of clinical circumstances.     

螺旋CT尿道三维重建诊断后尿道狭窄或闭锁

目的 探讨螺旋CT尿道三维重建技术在后尿道狭窄或闭锁诊断中的应用价值.方法 对30例创伤性后尿道狭窄或闭锁患者术前行螺旋CT薄层扫描和尿道三维重建、X线尿道造影,观察狭窄或闭锁部位、长度以及尿道周围组织解剖结构的改变,并与开放性手术中发现的结果进行对比研究.结果 X线尿道造影检测狭窄或闭锁段长度为1.0～7.0 cm,平均4.0 cm,狭窄或闭锁长度相关系数为0.92,定位准确率为70%(21/30);螺旋CT尿道三维重建检测狭窄或闭锁段长度为1.2～7.6 cm,平均4.3 cm,狭窄或闭锁长度相关系数为0.96,定位准确率为93%(28/30);术中发现后尿道狭窄或闭锁长度为1.5～7.5 cm,平均4.2 cm.5例合并尿道直肠瘘者螺旋CT尿道三维重建可以清楚显示瘘管位置、长度及大小;X线尿道造影则无法清楚显示.结论 螺旋CT尿道三维重建对了解伤后尿道的解剖结构改变、测量尿道狭窄或闭锁部位和长度、指导手术方式选择有较高价值,尤其对合并尿道直肠瘘者有重要的诊断意义.     

输尿管镜下杆状电极腔内治疗尿道狭窄

目的 探讨输尿管镜下杆状电极腔内治疗尿道狭窄的方法，提高手术技巧。方法 联合应用输尿管镜、自制杆状电极、等离子杆状电极等经尿道治疗56例男性尿道狭窄。患者年龄3～91岁，平均51岁。其中尿道下裂术后狭窄5例，外伤致狭窄7例，长期留置尿管致炎性尿道狭窄3例，金属尿道探子尿道扩张形成假道致狭窄9例，前列腺癌根治术后狭窄5例，前列腺摘除术后狭窄8例，前列腺电切术后狭窄19例。狭窄长度0．3～6．0cm，平均2．1cm。结果 55例(98．2％)手术成功，48例1次手术成功，7例2—3次腔内手术获成功，其中尿道下裂术后者2例，复杂性尿道狭窄者5例；1例反复内切开仍存在严重尿道瘢痕者改开放手术。结论联合应用输尿管镜、自制杆状电极、等离子杆状电极等腔内治疗尿道狭窄疗效满意。