尿道拖入术联合尿道吻合术与腔镜下尿道狭窄扩张术对外伤后骨盆骨折致后尿道狭窄患者术后功能恢复的影响

The effect of the pull-through operation combined with endoscopic dilation of urethra on functional recovery of traumatic urethral stricture patients caused by pelvic fracture

目的研究尿道拖入术联合尿道吻合术与腔镜下尿道狭窄扩张术对外伤后骨盆骨折致后尿道狭窄患者术后功能恢复的影响。方法前瞻性选取2015~2016年收治的外伤性骨盆骨折后致尿道狭窄的患者42例,随机将其分为两组,每组21例。治疗组患者给予尿道拖入术和尿道吻合术治疗,对照组患者给予腔镜下尿道狭窄扩张术治疗。比较两组的手术时间及出血量、术后患者的一般状况、性功能等因素,并分析两组的手术疗效。结果治疗组的手术时间、出血量、术后排气时间、住院时间明显高于对照组(P<0.05);治疗组的最大尿流速度、平均尿流速度均明显优于对照组(P<0.05);治疗组的性欲、勃起功能以及射精功能BMFSI评分均高于对照组(P<0.05);治疗组的手术优良率高于对照组,差异有统计学意义(P<0.05)。结论尽管尿道拖入术联合尿道吻合术的治疗对外伤性尿道狭窄的患者存在更大的创伤,术后的恢复速度也相对较慢,但是相对腔镜下尿道狭窄扩张术,前者对患者的功能恢复效用更明显。

Objective To study the effect of the pull-through operation combined with endoscopic dilation of urethra on functional recovery of traumatic urethral stricture patients caused by pelvic fracture.Methods Forty-two traumatic urethral stricture patients caused by pelvic fracture from 2015 to 2016 were prospectively selected and randomly divided into two groups,each group with 21 cases.The treatment group patients were treated with pull-through operation and urethral anastomosis operation,and the control group patients were treated with the endoscopic dilation of urethra.Operation time and bleeding,postoperative general condition of patients,sexual function and other factors were compared,and clinical efficacy of the two groups were analyzed.Results The operation time,bleeding volume,postoperative exhaust time and hospitalization time in the treatment group were significantly higher than those in the control group(P<0.05).The biggest urinary velocity and mean urinary flow rate of the treatment group were significantly better than those in the control group(P<0.05).The sexual function in the treatment group had got higher scores in sexuality,erectile function and ejaculatory function than the control group.The excellent rate of the treatment group was higher than that of the control group(P<0.05).Conclusion Although the pull-through operation combined with endoscopic dilation of urethra has greater trauma,postoperative recovery rate is relatively slow,but it has better effect of functional recovery.