前尿道狭窄术后再造尿道的细菌来源及治疗措施

Exploration of the source of bacteria in the neo-urethra after anterior urethroplasty

目的探讨前尿道狭窄术后重建尿道的细菌来源及应对措施。方法采集2014年7月至2017年4月我院收治的62例前尿道狭窄患者术前中段尿、再造尿道材料、术前尿道腔、术后尿道外口及术后再造尿道腔样本，检测细菌分布，并行脉冲场凝胶电泳（PFGE）分析从分子水平证实细菌的来源。患者均为男性，年龄10～68岁，平均35.6岁。行口腔黏膜尿道成形术21例，阴茎皮瓣尿道成形术23例，阴囊皮肤尿道成形术5例，阴茎皮瓣联合口腔黏膜尿道成形术9例，阴茎阴囊联合皮瓣尿道成形术3例，包皮皮瓣尿道成形术1例。结果41例患者术后尿道外口与再造尿道腔培养菌株一致，18例再造尿道材料与再造尿道腔培养菌株一致，7例术前尿道腔与再造尿道腔培养菌株一致，13例再造尿道腔内未采集到细菌，3例中段尿与再造尿道腔培养菌株一致。其中21例术后尿道外口、再造尿道材料、术前尿道腔、中段尿四者之中至少两者与再造尿道腔培养菌株一致。结论术后经尿道外口逆行进入是引起再造尿道感染的主要细菌来源，再造尿道腔内的细菌极少来自于尿液。围手术期针对再造尿道感染的细菌来源进行干预，是提高手术成功率的有效措施。

ObjectiveTo explore the reason that the neo-urethra infection after urethroplasty, and improve the perioperation procedures to reduce infection rate.MethodsThe clinical data of 62 anterior urethral stricture patients undergoing surgical treatment from July 2014 to April 2017 were analyzed. Then samples from urine, material for urethral reconstruction, urethra orifice and urethra were collected respectively. The bacterial culture, identification and pulsed field gel electrophoresis （PFGE） was performed. All the patients were males, and the mean age was 35.6 years （ranging 10-68 years）. Operation methods were urethroplasty using oral mucosa in 40 cases, using penile flap in 23, using scrotal flap in 5, using penile flap combined with oral mucosa in 9, using penile flap combined with scrotal flap in 3 and using preputial flap in 1.ResultsThe bacteria isolated from urethra orifice after operation were consistent with bacteria isolated from the neo-urethral lumen in 41 cases. There were 18 cases that shared the identical bacteria isolated from material for urethral reconstruction and neo-urethral lumen. In 7 patients, under careful isolation and identification, same bacteria were found to exist in both preoperative urethral lumen and neo-urethral lumen. Bacteria were not detected in the neo-urethral lumen in 13 cases. The bacteria isolated from urine were consistent with bacteria isolated from the neo-urethral lumen in 3 cases.ConclusionsThe bacteria in the neo-urethra mainly come from urethra orifice. Urine is not the main source for bacteria in neo-urethra. Perioperative intervention for sources of bacteria is an effective measure to improve the success rate of operation.