折刀位女性尿道憩室切除尿道重建术的临床疗效分析

Clinical analysis of female urethral diverticulum resection and reconstruction under Jacknife position

目的探讨折刀位女性尿道憩室切除尿道重建术的临床疗效。方法回顾性分析厦门大学附属第一医院2010年9月至2018年12月收治的22例女性尿道憩室患者的临床资料。年龄26~72岁,平均46.2岁;体质指数24.2~34.8 kg/m2,平均30.4 kg/m2。常见临床症状:11例(50%)尿痛,10例(45.5%)反复尿路感染,7例(31.2%)排尿困难,10例(45.5%)有尿道分泌物,9例(40.1%)性交困难;4例(18.2%)无临床症状。查体均可于阴道及尿道之间触及大小不一的肿物。22例行MRI检查示阴道内可见一长T1长T2的囊性信号灶。尿道憩室直径1.4~4.0 cm,平均2.8 cm。其中单纯型12例,马蹄型6例,圆周型4例。患者术中取俯卧折刀位下暴露阴道,纵行切开分离阴道黏膜组织,完整剥离憩室至颈口,切除后行尿道重建。记录手术情况及术后并发症和疗效。结果22例手术均顺利完成。术后随访8~42个月,平均25.2个月。其中1例术后2个月出现尿线细,复查彩色多普勒超声见残余尿量100 ml,经扩张尿道后症状好转;2例术后1个月复查有不同程度的下尿路刺激症状(1例有轻微尿痛,1例有尿路感染),予口服抗生素后症状好转。所有患者末次随访均未见尿道憩室复发。结论对于确诊的尿道憩室患者,采用折刀位下经阴道尿道憩室切除尿道重建术的成功率高,术后并发症少,复发率低。

Objective To explore the clinical efficacy of female urethral diverticulum resection and reconstruction under the folding position.Methods Retrospective analysis of 22 female patients with urethral diverticulum was performed from September 2010 to December 2018.There were 12 cases of simple diverticulum,6 cases of horseshoe diverticulum,4 cases of circumferential diverticulum,aged from 26 to 72 years,with an average of 46.2 years,whose BMI ranged from 24.2 to 34.8 kg/m2,with an average of 30.4 kg/m2.Eleven cases(50%)presented with dysuria,10 cases(45.5%)with repeated urinary tract infections,7 cases(31.2%)with difficulty of voiding,10 cases(45.5%)with urethral secretion,9 cases(40.1%)with difficulty of sexual intercourse,and 4 cases(18.2%)without symptoms.Unlike the traditional surgical procedure under the lithotomy position,the folding position was used to expose the vagina and separate the vaginal mucosa by longitudinal incision,and the diverticulum was completely removed to the neck.The peri-operative complications and efficacy were recorded.Results All 22 cases underwent successful procedures,and were followed up for 25.2 months on average(ranged 8 to 42 months).One of them suffered from weak stream 2 months after operation,with residual urine volume of 100ml by ultrasonography.Her symptoms improved after dilatation of the urethra.Two cases suffered from different degrees of lower urinary tract storage symptoms 1 month after the operation(1 case of mild dysuria and 1 case of urinary tract infection),who improved after oral administration of levofloxacin tablets for 3-5 days.All patients had no urethral diverticulum recurrence 3 months later by ultrasonography,half a year by cystoscopy,and every six months by ultrasonography.Conclusions Surgical treatment is still the best choice for patients with urethral diverticulum.The success rate of transvaginal urethral diverticulum reconstruction with a Jackknife position is high,postoperative recurrence rate is low,and postoperative complications are few.