尿道内切开术联合曲安奈德注射治疗尿道狭窄疗效研究

Internal Urethrotomy Combined with Triamcinolone Injection in the Treatment of Male Urethral Stricture

目的探讨尿道内切开术联合曲安奈德瘢痕内注射治疗男性尿道狭窄的临床疗效。方法回顾性分析2008年1月—2010年12月我院收治的男性尿道狭窄患者44例,其中试验组21例行尿道内切开术联合曲安奈德瘢痕内注射治疗,对照组23例行尿道内切开术。试验组于狭窄段3、6、9、12点冷刀放射状切开瘢痕组织后,用自制F4尿道注射针抽取20 ml曲安奈德注射液,环状注射于瘢痕切开基底部组织中;对照组仅行狭窄段瘢痕组织放射状切开。观察记录两组术后最大尿流率(Qmax)、狭窄段内径的变化以及尿道狭窄复发情况和复发间隔时间。结果 44例患者均一次手术切开成功,拔除导尿管后均能自主排尿,平均随访(8.7±5.4)个月。治疗前试验组年龄、随访时间、Qmax及狭窄段内径与对照组比较,差异均无统计学意义(P>0.05);而治疗后6个月和1年的复发率、Qmax、狭窄段内径、复发间隔时间与对照组比较,差异均有统计学意义(P<0.05)。结论对于≤1.5 cm的尿道狭窄,应用尿道内切开术联合曲安奈德瘢痕内注射对延缓狭窄复发有较好的应用价值。

Objective To investigate clinical efficacy of internal urethrotomy combined with corticosteroid injection in urethral scar tissue in the treatment of urethral stricture. Methods 44 patients with urethral stricture admitted to our hospital from January 2008 to December 2010 were retrospectively analyzed. The 21 cases in the experiment group was given internal urethroto- my combined with corticosteroid injection in urethral scar tissue, while the 23 cases in the control group was only given internal urethrotomy. In experiment group, cold knife was used to incide radially the scar tissue in the narrow section 3, 6, 9, 12 lines. Besides, 20 ml triameinolone was injected circularly in the open gap of the scar basal tissue by self- made F4 urethral in- jection needle. The control group was only incided radially the scar tissue in the narrow section. Postoperative maximum flow rate, inner diameter changes of narrow section and urethral stricture recurrence and recurrence interval were compared between two groups. Results The 44 patients all had first time success of surgery, and were able to urinate by themselves after removal of catheter with an average follow - up of （ 8.7 ± 5.4） months. Before treatment, the age, follow - up time, Qmax and urethral stricture inner diameter of two groups showed no statistically significant difference （ P 〉 0. 05 ） . After treatment of six months and one year, strieture reeurrence rate the Qmax, urethral stricture inner diameter, and recurrence interval of two groups showed sta- tistically significant differences （ P 〈 0.05 ） . Conclusion For the male urethral stricture within 1.5 era, internal urethrotomy combined with triameinolone injection has good application value for delaying postoperative urethral stricture scar recurrence.