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。

Recognition the Outcome of Direct Visual Internal Urethrotomy

Objective:To evaluate the long-term results of direct visual internal urethrotomy (DVIU) and its value in clinical application. Methods:From January 2003 to January 2007, 65 patients suffered with urethral stric-ture accepted DVIU procedure. The data of follow-up were recorded in this study. The length of stricture ranged from 0.5 to 2 cm (mean 1.2 cm). Of the 65 men, 25 were found obvious urethra stricture in less than 1.0 cm, and the others 1.1 to 2.0 cm. Urethral ultrasound was conducted in 30 patients, which showed that 10 patients with thickness of scar around urethra were less than 1 cm, 20 patients more than 1 era, and 9 patients with both length and thickness of scar less than 1 cm. Results:Of the 65 patients, DVIU were conducted 72 times. All the operations were successful. 63 patients were followed-up from 24 to 60 months (mean 40.5 months). Opening procedures were performed in 48 patients (76.2%) due to recurrence. In 10 patients whose scar thickness around urethra less than 1 cm, only 1 patient was accepted opern operation. However, 18 of 20 patients with scar thick-ness more than 1 cm underwent opern operation. 9 patients with scar length and thickness less than 1 cm were completely successful. Conclusions: Patients whose scar length and thickness less than 1 cm may be optimal for DVIU. Repeated DVIU are unnecessary. Reasonable indication is related to the efficacy of this procedure.