狭窄段切除补片尿道扩大成形术在治疗尿道球部狭窄中的应用

Application of augmented anastomotic urethroplasty for treatment of bulbar urethral stricture

目的:综述狭窄段切除补片尿道扩大成形术在尿道重建中的应用,评估其手术效果及并发症的发生率。方法:利用PubMed/Medline检索有关狭窄段切除补片尿道扩大成形术治疗尿道球部狭窄的临床研究文章,提取数据,对其进行总结分析。同时对资料结果中行腹侧补片和背侧补片替代尿道的成功率进行χ~2检验,采用SPSS 19.0进行统计分析。结果:共纳入11篇文章,共有597例患者进行了狭窄段切除补片尿道扩大成形术,总体成功率达91.3%,其中行腹侧补片替代尿道的总体成功率91.3%,行背侧补片替代尿道的总体成功率92.1%,二者差异无统计学意义(χ~2=0.097,P=0.756)。术后并发症以勃起功能障碍和尿外渗最为多见,勃起功能障碍总体发生率为4.9%,尿外渗的总体发生率为4.5%,未见术后阴茎下弯的报道。结论:狭窄段切除补片尿道扩大成形术手术成功率高,术后并发症小,是治疗尿道球部狭窄的有效手术方式,同时腹侧补片与背侧补片相比较,二者在手术成功率上差异无统计学意义。

Objective： To review the application of augmented anastomotic urethroplasty in urethral reconstruc- tion and assess its efficacy and the incidence of complications. Method： Related clinical research papers on the use of augmented anastomotic urethroplasty for treatment of bulbar urethral stricture were searched via PubMed/Med- line. The data were extracted and summarized. In addition, the success rate of augmented anastomotic urethro- plasty by the approach of ventral patch and dorsal patch was analyzed by SPSS 19.0 software. Result： A total of 11 studies were included, involving 597 patients with an overall success rate 91.3%. There was no statistical sig- nificance between the approach of ventral patch with an overall success rate 91.3% and the approach of dorsal patch with an overall success rate of 92. 1% （X^2 = 0. 097, P= 0. 756）. Erectile dysfunction and urinary extravasa- tion were the most common postoperative complications. The overall incidence of erectile dysfunction was 4.9 and the overall incidence of urinary extravasation was 4.5%. No penile curvature was reported. Conclusion： Aug- mented anastomotic urethroplasty was an effective procedure for treatment of bulbar urethral stricture with high success rate and low incidence of postoperative complications. Meanwhile, there was no difference in success rate between the approach of ventral patch and dorsal patch.