经尿道前列腺电切术后并发尿道狭窄原因及防治分析

Analysis of causes and prevention of urethral stricture after transurethral resection of prostate

目的分析经尿道前列腺电切术后并发尿道狭窄的原因及防治方法。方法选取我院收治的480例良性前列腺增生患者,均接受经尿道前列腺电切术治疗,选择发生尿道狭窄的28例为研究对象,根据患者病情分别选择尿道外口切开术、尿道内切开术、尿道狭窄段切除重吻合术、狭窄段尿道切开术、尿道成形术等治疗。观察治疗效果及随访前列腺症状(IPSS)评分、生活质量(QOL)评分、残余尿量(RUV)、最大尿流率(Qmax)等改善情况。结果 28例患者均手术成功,手术成功率达100%。28例患者均获得随访,随访期间尿道狭窄1例复发,复发率为3.57%。治疗后IPSS评分、QOL评分、Qmax、RUV显著优于治疗前,差异有统计学意义(P<0.05)。术中因素在并发尿道狭窄中所占比例显著高于其他原因,差异有统计学意义(P<0.05)。结论临床工作中需根据总结的前列腺电切术并发尿道狭窄原因,采取针对性的防治措施,以早期发现、早期治疗尿道狭窄,减轻患者痛苦。

Objective To analyze the causes and prevention of urethral stricture after transurethral resection of prostate.Methods Four hundred and eighty patients with benign prostatic hyperplasia were treated by urethral prostate resection,and 28 cases of urethral stricture were selected as the study subjects. External urethral incision, interna urethrdomy, urethral stricture resection and anastomosis, narrow segment urethral incision, urethroplasty and other treatment methods were selected according to the patient＇s conditions. The effects of treatment and follow up on prostate symptom（IPSS） score,quality of life（QOL） score, residual urine volume（RUV）, and maximum urinary flow rate（Qmax） were observed. Results Twenty-eight patients successfully operated, the success rate of operation was 100%. 28 patients were all followed up, 1 case of urethral stricture recurred during the follow-up period, the recurrence rate was 3.57%. After treatment, IPSS score,QOL score, Qmax, RUV were significantly better than those before treatment, the differences were statistically significant（P 0.05）. The proportion of intraoperative factors was significantly higher than other causes of complicated with urethral stricture, the difference was statistically significant（P 0.05）. Conclusion According to the summary of the causes of prostate transurethral resection of urethral stricture in the clinical work, targeted prevention and treatment measures should be taken so as to conductive to early detection, early treatment of urethral stricture, and reducing the pain of patients.