不同手术方法治疗男性外伤性尿道狭窄的多中心临床研究

目的探讨不同手术方法影响男性外伤性尿道狭窄治疗效果的相关因素。方法回顾性分析多中心的237例外伤性尿道狭窄的初次治疗效果,采用多因素分析,用卡方、卡方分割分析的统计方法分析临床疗效。结果在狭窄复发的因素中,狭窄长度分组（0～2cm,2～4cm）的P〈0.05,围手术期尿路感染的P〈0.05,狭窄初次治疗方式（尿扩,尿道内切开,尿道吻合）的P〈0.05;狭窄的初次治疗方式,尿扩与尿道吻合比较P〈0.01,尿道内切开与尿扩比较的P〉0.05,尿道内切开与尿道吻合比较P〈0.01。结论外伤导致的尿道狭窄长度、围手术期尿路感染、狭窄初次治疗方式是影响尿道狭窄复发的重要因素;尿道狭窄的长度与尿道内切开的疗效相关,狭窄长度〈2cm复发率低,〉2cm复发率高;尿道吻合术的影响因素与狭窄长度、狭窄部位、既往手术史无关,与围手术期尿路感染及手术本身有关,与其他手术方式相比,尿道吻合治疗外伤性尿道狭窄复发率最低。

Multi-center clinical research of different surgical treatment of male traumatic urethral stricture

Objective To discuss the influencing facts of the outcome of different surgical treatment of male traumatic urethral stricture.Methods The maiden therapy effects of 237 cases of traumatic urethral stricture of multi-center were reviewed and tested by Log-rank and Chi-square test and partitions of χ2.Results The length of the stricture was divided into two groups.In grpup 1,the length was 0-2 cm,but in group2 the length was 2-4 cm.The recurrence rate in group 2 was significantly higher than that in group1（P0.05）.The recurrence rate in patients with perioperative urinary infection was significantly higher than that in patients without perioperative urinary infection（P0.05）.In maiden therapy methods of stricture,The recurrence rate in patients with urethral dilatation was significantly higher than that in patients with anastomotic urethroplasty（P0.01）,but no significance between urethral dilatation and internal urethrotomy（P0.05）.And the recurrence rate in patients with internal urethrotomy was significantly higher than that in patients with anastomotic urethroplasty（P0.01）.Conclusions The length of the stricture,perioperative urinary infection and maiden therapy methods of stricture are all important factors of the recurrence of urethral stricture;The incidence of urethral stricture recurrence is relation to the length of the stricture after urethrotomy.If the length of the stricture shorter than 2cm the incidence of urethral stricture recurrence is low,in contrast,if the length longer than 2cm the incidence is high;After anastomotic urethroplasty the incidence of urethral stricture recurrence is relation to perioperative urinary infection and operation,but is not relation to length of the stricture,site of stricture and previous stricture treatment.Compared with other surgical treatment,the incidence of urethral stricture recurrence of anastomotic urethroplasty is the lowest.