双窥镜下尿道会师术治疗男性尿道损伤的临床价值

Clinical value of both ureteroscopy and cystoscopy urethral realignment for the treatment of male urethral injury

目的探讨双窥镜下尿道会师术治疗男性尿道损伤的临床价值,为男性尿道损伤治疗提供参考。方法选取2010年1月至2015年1月期间在嘉应学院医学院附属医院住院治疗的80例男性尿道损伤患者,按照数字表格法随机分为A组和B组,每组40例,A组行输尿管硬镜下尿道会师术治疗,B组行输尿管镜与膀胱镜双窥镜下尿道会师术治疗,观察两组患者的治疗效果和并发症(尿道狭窄、尿失禁、勃起功能障碍)发生情况。结果 A组患者中有6例因损伤严重术中转为开放手术,B组均手术成功;B组患者的手术时间、灌注液体量、术中出血量分别为(26.7±11.5)min、(288.3±40.3)m L、(29.2±12.8)m L,分别短于(少于)A组的(32.2±8.4)min、(320.8±45.9)m L、(35.9±14.9)m L,差异均有统计学意义(P<0.05);B组患者的手术成功率为100.0%,明显高于A组的85.0%,差异有统计学意义(P<0.05);B组患者术后3个月内并发症发生率为5.0%,低于A组的20.0%,差异有统计学意义(P<0.05)。A组患者的治愈率、好转率分别为70.0%、30.0%,B组分别为90.0%、10.0%,差异均有统计学意义(P<0.05)。结论双窥镜下尿道会师术治疗男性尿道损伤疗效肯定,较输尿管镜尿道会师术手术成功率高,术后并发症发生率低。

Objective To explore the clinical value of both ureteroscopy and cystoscopy urethral realignment for male urethral injury, and provide reference for the treatment of male urethral injury. Methods A total of 80 patients with urethral injury hospitalized in the Affiliated Hospital of Medical College of Jiaying University from January2010 to January 2015 were investigated. They were divided into A group and B group by a random number table（40cases in each group）. A hard ureteroscopy urethral realignment treatment was adopted for A group, and a combined type treatment of urethral realignment comprising both ureteroscopy and cystoscopy was adopted for B group. The therapeutic effects and complications（urethral stricture, urinary incontinence, erectile dysfunction） of the two groups were observed. Results In group A, 6 patients with severe injuries converted to open surgery, while in group B, all were successful. The operation time,perfusion liquid amount and the intraoperative blood loss in B group were（26.7 ± 11.5） min,（288.3 ± 40.3） m L, and（29.2 ± 12.8） m L, respectively, which were shorter（less） than（32.2±8.4） min,（320.8±45.9） m L, and（35.9±14.9） m L in A group（P〈0.05）. The success rate of operation in B group was 100.0%, which was significantly higher than that in A group（85.0%）; the complication rate of B group within 3months after surgery（5.0%） was significantly lower than that in A group（20.0%）; and the cure rate and improvement rate of B group were 90.0% and 10.0%, as compared with 70.0% and 30.0% in group A（P〈0.05）. Conclusions The curative effect of urethral realignment for male urethral injury by using both ureteroscopy and cystoscopy was significant.Compared with ureteroscopy urethral realignment surgery, the combination has a high success rate, and low incidence of postoperative complications.