前尿道狭窄病因及疗效初步探讨

The preliminary analyse of the cause and therapeutic effect for anterior urethra stricture

目的探讨前尿道狭窄的病因和手术治疗的时机、方法和疗效。方法对于尿道外口狭窄采用尿道扩张、人工尿道下裂方法;对于前尿道膜状狭窄及狭窄段在2 cm以内,在电切镜直视下以冷刀放射状切开;对于复杂的、多处狭窄的患者采用内切开结合狭窄段切除吻合的方法,术后定期尿道扩张。结果 77例患者,术后随访3个月～6年,尿道外口成形27例全部治愈,尿道扩张术者14例,11例获治愈,3例失败改行内切开。另有10例复杂前尿道狭窄,切除尿道端端吻合术7例成功,失败3例。5例患者排尿不畅,再次手术治疗,其中2例改行会阴造瘘。结论尿道扩张、人工尿道下裂、直视下内切开是治疗前尿道狭窄的常用方法。尿道内外联合切开治疗严重的前尿道多发性狭窄,术后定期随访及尿道扩张十分必要。预防及控制尿道慢性炎症是减少前尿道狭窄的有效措施。

Aim To analyse the cause and therapeutic opportunity,methods and therapeutic effects for anterior urethra stricture.Methods For the stricture of external orifice of urethra,adopted urethral sounding,artificial hypospadias;For the stricture of urethral membranes and the stricture portion less than 2cm,radial incision under resectoscope;For complicated,multiple stricture of external orifice of urethra,interior incision combine resection of stricture section and anastomosis,then urethral sounding regularly.Results 77cases,Followup of 3 months ～ 6 years.Reshaping of external orifice of urethra for 27 cases all healing well;14 cases accepted dilation of urethra,11 cases curative effect well,3 cases among 14,adopted interior incision.Another 10 complicated cases,to resect the stricture section and anastomosis,7 cases urinate recovery well and 3 cases failure.5 cases difficulty of urination,underwent reoperation,2 in 5 cases to apply perineostomy.Conclusion Urethral sounding,artificial hypospadias and interior incision are the effective methods.Interior incision combine external incision for severe and multiple anterior urethra stricture.It is very necessary that regular follow-up and urethral sounding regularly.To prevent and control urethral chronic inflammation is an effective measure to reduce anterior urethra stricture.