闭合性尿道损伤几种手术方法比较

Comparison of several surgical treatments for closed urethral injury

目的 比较闭合性尿道损伤几种手术方法的疗效. 方法 回顾性分析2012年6月-2012年6月手术治疗的闭合性前后尿道外伤患者200例,其中44例前尿道损伤患者（前腔镜组）行经尿道腔镜下尿道会师术,32例前尿道损伤患者行经会阴尿道修补术（修补组）,42例后尿道损伤患者行经会阴尿道端端吻合术（吻合组）,35例后尿道损伤患者行经尿道腔镜下尿道会师术（后腔镜组）,47例后尿道损伤患者行经尿道联合经膀胱腔镜下尿道会师术（联合腔镜组）,比较不同手术方法的出血量和手术时间、住院时间和费用、尿道狭窄和勃起功能障碍（erectile dysfunction,ED）发生率,评价疗效. 结果 前腔镜组较修补组手术出血量[（10±5）ml∶ （100±20）ml]少（P＜0.05）,手术时间[（15 ±6） min∶ （40±15） min]和住院时间[（14.2 ±1.8） min∶（28.5±1.5） min]短（P＜0.05）,住院费用[（4715.42 ±225.43）元：（6886.46±246.78）元]及尿道狭窄发生率（39％：63％）低（P＜0.05）,但ED发生率两组差异无统计学意义.吻合组手术出血量最多,为（200 ±30） ml（P ＜0.05）,手术时间最长,为（60±20） min,住院时间最长,为（28.7±2.3） d（P ＜0.05）,住院费用最高,为（6964.27±275.69）元（P＜0.05）,尿道狭窄发生率最高,为95％ （P ＜0.05）.后腔镜组较联合腔镜组手术出血量[（15 ±6） ml∶（50±12） ml]少（P＜0.05）、手术时间[（21.4±1.7） min∶（21.2±1.5） min]短（P＜0.05）,但住院时间、住院费用及尿道狭窄发生率两组差异无统计学意义.吻合组、后腔镜组及联合腔镜组ED发生率差异无统计学意义. 结论 与传统手术比较,腔镜具有出血量少、手术时间及住院时间短、住院费用低等优点,尿道狭窄和ED发生率与损伤部位和严重程度密切相关.

Objective To compare the curative effect of several surgical treatments for closed u- rethral injury. Methods A retrospective study was done on 200 cases of closed urethral injury treated with various methods from June 2002 to June 2012, including 44 cases of anterior urethral injury treated with endoscopic transurethral realignment （anterior endoscopic group） , 32 cases of anterior urethral inju- ry with transperineal urethral repair （repair group） , 42 cases of posterior urethral injury with transperine- al urethral termino-terminal anastomosis （anastomosis group）, 35 cases of posterior urethral injury with endoscopic transurethral realignment （posterior endoscopic group） , and 47 cases of posterior urethral in- jury with endoscopic transurethral and transvesieal realignment （combined endoscopic group）. Amount of bleeding, operation time, hospital stay as well as expense, and rate of urethral stricture and erectile dys- function （ED） in treatment of anterior and posterior urethral injury were compared respectively. Curative effect and merits and faults of each treatment were observed. Results Anterior endoscopic group a- chieved less bleeding [ （ 10 ± 5） ml： （ 100± 20） ml, P 〈 0.05 ], shorter operation time and hospital stay （ 15 ± 6） min： （40 ± 15 ） min, （ 14.2 ± 1.8 ） min： （ 28.5 ± 1.5 ） min respectively, P 〈 O. 051 , lower hospital expense and urethral stricture rate[ （4 715.42 ± 225.43 ） RMB： （6 886.46 ± 246.78 ） RMB, 39% ： 63% respectively, P 〈 0.05 ] as compared with repair group, but there was no statistical difference in ED rate between the two groups. Whereas in anastomosis group, the most bleeding [ （200 -±30） ml], longest operation time [ （60 ±20） minutes ] and hospital stay [ （ 28.7 ± 2.3 ） days ], and highest hospital expense [ （6 964.27 ± 275.69 ） RMB 1 and urethral stricture rate （95 % ） were detected （ P 〈 0.05 ）. Poste- rior endoscopic group presented less bleeding [ （ 15 ±6） ml： （50 ~ 12） ml, P 〈0.051 and shorter operation time [ （21.4 _＋ 1.7） min： （21.2 ＋ 1.5 ） min, P 〈 O. 05 ~ as compared with combined endoscopic group, but there were no statistical differences in hospital stay as well as expense and urethral stricture rate be- tween the two groups. Moreover, ED rate was not statistically different among anastomosis group, posteri- or endoscopic group and combined endoscopic group. Conclusions Endoscopic surgery is superior to traditional surgery in terms of blood loss, operation time, hospital stay, and hospital cost. Besides, ure- thral stricture and ED rates are closely related to the location and severity of injury.