会阴部造瘘分期尿道成形术治疗超长段尿道狭窄的疗效评估

目的:调查会阴部造瘘分期尿道成形术对超长段尿道狭窄的治疗效果,并评估手术对患者生活质量的影响。方法:回顾性调查2000～2010年间收治的54例超长段尿道狭窄患者(平均年龄40岁,狭窄长度平均6.5 cm)接受分期会阴部造瘘尿道成形手术疗效;并通过问卷调查的形式对其术后生活质量进行评估。疗效评估方式包括对排尿困难相关症状评分(IPSS)、自由尿流率、是否需要尿道扩张及患者主观对手术效果满意度。结果:54例患者会阴部造瘘术后最大尿流率为(14.0±4.7)ml/min,其中34例接受二期手术的患者中22例患者(64.7%)排尿通畅,最大尿流率为(12.0±3.5)ml/min,8例(23.5%)需定期尿道扩张,4例(11.8%)因吻合口再狭窄接受尿道内切开术。会阴部一期造瘘术后和二期术后IPSS评分分别为(5.4±2.1)分和(8.5±5.8)分,较术前[(27.3±24.5)分]有明显差异(P<0.01),术后生活质量满意度总体为92.6%(会阴部造瘘术)和64.7%(二期手术)。结论:会阴部造瘘+分期尿道成形术安全有效,术后患者满意度及生活质量较高,是治疗超长段尿道狭窄较为理想的手术方式。

Perineal urethrostomy plus secondary urethroplasty for ultralong urethral stricture: clinical outcomes and influence on the patient's quality of life

Objective: To investigate the outcomes of perineal urethrostomy plus secondary urethroplasty for ultralong urethral stricture and assess its influence on the patient’s quality of life.Methods: We retrospectively analyzed 54 cases of ultralong urethral stricture treated by perineal urethrostomy from 2000 to 2010.The mean age of the patients was 40 years,and the average length of stricture was 6.5 cm.We evaluated the patients’ quality of life by questionnaire investigation and the clinical outcomes based on IPSS,Qmax,the necessity of urethral dilation and satisfaction of the patients.Results: The mean Qmax of the 54 patients was(14.0±4.7) ml/min.Of the 34 cases that underwent secondary urethroplasty,22(64.7%) achieved a mean Qmax of(12.0±3.5) ml/min,8(23.5%) needed regular urethral dilatation and 4(11.8%) received internal urethrotomy because of restenosis.IPSS scores were 5.4±2.1 and 8.5±5.8 after perineal urethrostomy and secondary urethroplasty,respectively.Fifty of the total number of patients(92.6%) were satisfied with the results of perineal urethrostomy,and 22 of the 34(64.7%) with the results of secondary urethroplasty.Conclusion: Perineal urethrostomy plus secondary uretroplasty is safe and effective for ultralong urethral stricture,and affects very little the patient’s quality of life.