尿道吻合术后留置尿管时间与远期效果的相关性观察

Relationship between the duration of catheter placement after anastomotic urethroplasty and the long-term efficacy

目的分析探讨尿道吻合术后留置尿管时间与远期效果的相关性。方法将19例患者随机分两组，均急诊一期行尿道吻合术，在不同时间段拔除尿管后观察吻合段尿道狭窄情况并进行临床效果对比。结果A组9例术后4周拔尿管，常规定期尿道扩张，随访6～12个月。A组中7例（77．8％）无吻合段尿道继发狭窄，最大尿流率15．3。31．1ml／s，平均22．1ml／s；术后常规3个月每月1次膀胱镜检，均顺利通过F21膀胱镜；A组中2例（22．2％）吻合段尿管继发狭窄，需再行吻合段尿道疤痕切除吻合术。B组10例术后12周拔除尿管，最大尿流率19．2。38．5ml／s，平均24．3ml／s，本组均未作尿道扩张；术后常规3个月每月1次膀胱镜检查，均能顺利通过F21膀胱镜，随访6～12个月，吻合段尿道无继发狭窄。结论尿道吻合术后，3个月内尿道留置尿管时间与吻合段尿道狭窄发生率呈负相关。

Objective To explore the relationship between the duration of catheter placement after anastomotic urethroplasty and the long-term efficacy. Methods 19 patients were randomly divided into two groups and received emergency anastomotic urethroplasty. After removal of the catheter at different periods of time, occurrence of urethral stricture in the anastomotic segment was observed and the clinical outcomes were compared. Results In group A, all 9 patients received catheter removal 4 weeks after the procedure, underwent urethral dilatation, and were fallowed up for 6 -12 months; 7 of 9 （ 77.8% ） patients had no secondary urethral stricture in the anastomotic segment, with a highest urinart rate of 15.3 31.1 ml/s, 22.1 ml/sin average the patients received routine cystscopy postoperatively once a month for 3 months and the F21 cystscope could pass smoothly; 2 （ 22.2% ） patients occurred urethral stricture and needed scar removal and then anastomosis. In group B, all 10 patients received catheter removal 12 weeks after the procedure, with a highest urinary rate of 19.2 - 38.5 ml/s, 24.3 ml/sin average, but received no urethral dilatation, and received the same cystscopic examination and the F21 cystscope could pass smoothly; the patients were also followed up for 6 - 12 months and no urethral stricture was found. Conclusions Within 3 months after anastomotic urethroplasty, the time of catheter placement in the urethra is positively related with the incidence rate of urethral stricture in the anastomotic segment.