闭合性尿道球部损伤不同手术治疗效果与术后狭窄处理分析

目的比较闭合性尿道球部损伤早期行耻骨上膀胱造瘘术与膀胱镜下留置尿管术的临床效果及术后狭窄处理。方法回顾性分析2012年6月至2017年6月就诊的57例闭合性尿道球部损伤患者,耻骨上膀胱造瘘患者24例(造瘘组),膀胱镜下留置尿管患者33例(置管组)。随访期间发生狭窄的患者,根据狭窄程度行微创手术(内镜下尿道内切开术或尿道扩张术)或开放修复手术。比较两组患者术后狭窄的发生率、狭窄段长度、勃起功能障碍(ED)发生率。比较早期行膀胱镜下留置尿管治疗后发生狭窄的患者与早期行耻骨上膀胱造瘘治疗后发生狭窄的患者经微创手术治愈的比例。结果造瘘组和置管组术后狭窄发生率分别为33.33%(8/24)和63.64%(21/33),差异有统计学意义(P<0.05);狭窄段长度分别是(1.17±0.42)cm和(1.38±0.44)cm,差异无统计学意义(P>0.05),造瘘组与置管组ED发生率分别是4.17%(1/24)和6.06%(2/33),差异无统计学意义(P>0.05)。早期行膀胱镜下留置尿管治疗后发生狭窄的患者与早期行耻骨上膀胱造瘘治疗后发生狭窄的患者通过微创手术治愈比例的差异无统计学意义(χ^2=2.032,P=0.154)。结论尿道球部损伤患者早期行耻骨上膀胱造瘘可能降低术后尿道狭窄的发生,但对狭窄段长度及ED的发生可能无影响。

Analysis of different surgical treatment and postoperative stricture treatment in closed bulbar urethral injury

Objective To compare clinical results and postoperative stricture treatment of early suprapubic cystostomy or cystoscope for urethral catheterization in closed bulbar urethral injury.Methods A retrospective study was done on 57 cases of closed bulbar urethral injury in our hospital from June 2012 to June 2017,24 cases treated with suprapubic cystostomy,33 cases with cystoscope for urethral catheterization.Patients with stricture during follow-up underwent minimally invasive surgery(visual internal urethrotomy or urethral dilatation)or open repair surgery depending on the degree of stricture.The rate of urethral stricture,the length of urethral stricture,the rate of erectile dysfunction(ED).The proportion of patients cured by minimally invasive surgery after urethral stricture were compared between early suprapubic cystostomy and cystoscope for urethral catheterization.Results In these two groups,the rates of urethral stricture were 33.33%(8/24)and 63.64%(21/33)(P<0.05),the length of urethral stricture were(1.17±0.42)cm and(1.38±0.44)cm(P>0.05),the rates of ED were 4.17%(1/24)and 6.06%(2/33)(P>0.05).There is no different in the proportion of patients cured by minimally invasive surgery after urethral stricture between early suprapubic cystostomy and cystoscope for urethral catheterization(χ2=2.032,P=0.154).Conclusions Suprapubic cystostomy as a primary treatment after bulbar urethral injury may reduce the formation of postoperative urethral stricture,it has no effect on the length of urethral stricture,the rate of ED.