输尿管镜下尿道会师术治疗男性闭合性尿道损伤临床观察

Clinical effect of urethral realignment under ureteroscope on male patients with closed urethral injury

目的探究输尿管镜下尿道会师术对男性闭合性尿道损伤(UI)患者围手术期指标、疼痛程度、炎性因子、排尿和勃起功能的影响。方法选取2019-01-01-2022-01-31信阳市人民医院收治的78例男性闭合性UI患者临床资料,根据治疗方法不同,分为输尿管镜组(n=39)和常规手术组(n=39)。常规手术组实施常规的尿道会师术,输尿管镜组在输尿管镜下实施尿道会师术。对比2组围手术期指标,术前及术后3d疼痛程度〔视觉模拟量表(VAS评分)〕、炎性介质水平,术前与术后3个月排尿功能、勃起功能〔勃起功能简易量表(IIEF-5)评分〕及并发症情况。结果输尿管镜组术中总失血量为(28.47±6.43)mL,低于常规手术组的(86.35±11.54)mL,差异有统计学意义,t=27.312,P<0.001;输尿管镜组手术用时、总住院天数分别为(24.59±6.42)min、(9.32±2.33)d,短于常规手术组的(46.73±7.44)min、(13.74±3.21)d,差异有统计学意义,t值分别为14.070和6.959,均P<0.001;术后3d,输尿管镜组VAS评分为(1.69±0.95)分,低于常规手术组的(3.10±1.05)分,差异有统计学意义,F=19.383,P<0.001;术后3d,输尿管镜组肿瘤坏死因子-α(TNF-α)、单核细胞趋化蛋白-1(MCP-1)、白介素-8(IL-8)、C反应蛋白(CRP)水平分别为(46.73±9.58)ng/L、(278.53±38.55)ng/L、(74.22±12.35)μg/L、(41.36±7.13)mg/L,低于常规手术组的(52.77±10.36)ng/L、(315.74±36.72)ng/L、(82.79±13.44)μg/L、(47.95±8.52)mg/L,差异有统计学意义,F值分别为3.677、9.423、6.404和6.790,P值分别为0.030、<0.001、0.003和0.002;术后3个月,输尿管镜组最大尿流率(Qmax)、IIEF-5评分分别为(18.95±3.24)mL/s、(19.41±4.36)分,高于常规手术组的(16.36±3.85)mL/s、(16.59±4.77)分,残余尿量(RUV)为(26.82±4.22)mL,低于常规手术组的(30.28±4.56)mL,差异有统计学意义,F值分别为5.270、5.340和6.356,P值分别为0.007、0.007和0.003;输尿管镜组并发症总发生率(10.26%)低于常规手术组(28.21%),差异有统计学意义,χ^(2)=4.404,P=0.044。结论输尿管镜下尿道会师术治疗男性闭合性UI患者能改善围手术期指标和机体的炎性状态,能有效缓解患者的术后疼痛程度,改善排尿情况,提高患者的勃起功能,且安全性较高。

Objective To investigate the effect of urethral realignment under ureteroscope on perioperative indexes,pain degree,inflammatory factors,urination and erectile function of male patients with closed urethral injury(UI).Methods The clinical data of 78male patients with closed UI admitted by Xinyang People's Hospital from January 1,2019to January 31,2022were selected and divided into ureteroscope group(n=39)and conventional surgery group(n=39)according to different treatment methods.The conventional operation group performed routine urethral realignment,and the ureteroscope group performed urethral realignment under ureteroscope.The perioperative indexes,pain degree before sugery and 3days after surgery[visual analog scale(VAS)score],inflammatory media level,urination function before surgery and 3months after surgery,erectile function[international erectile function index-5(IIEF-5)score]and complications were compared between the two groups.Results The total intraoperative blood loss in the ureteroscope group was(28.47±6.43)ml,lower than that in the conventional surgery group(86.35±11.54)ml,with a statistically significant difference(t=27.312,P<0.001);the operation time and total hospital stay in the ureteroscope group were(24.59±6.42)min and(9.32±2.33)d,respectively,which were shorter than those in the conventional surgery group(46.73±7.44)min and(13.74±3.21)d,with statistically significant differences(t value were 14.070and 6.959,respectively,P<0.001).After 3days of operation,the VAS score was(1.69±0.95)points,which was lower than that in the conventional surgery group(3.10±1.05)points,with a statistically significant difference(F=19.383,P<0.001);after 3days of operation,the levels of tumor necrosis factor-α(TNF-α),monocyte chemoattractant protein-1(MCP-1),interleukin-8(IL-8)and C-reactive protein(CRP)in ureteroscope group were(46.73±9.58)ng/L,(278.53±38.55)ng/L,(74.22±12.35)μg/L,(41.36±7.13)mg/L,respectively,which were lower than those in the conventional surgery group(52.77±10.36)ng/L,(315.74±36.72)ng/L,(82.79±13.44)μg/L,(47.95±8.52)mg/L,the differences were statistically significant(Fvalue were 3.677,9.423,6.404,6.790,Pvalue were 0.030,<0.001,0.003,0.002,respectively).After 3months of operation,the maximum urinary flow rate(Qmax)and IIEF-5scores in the ureteroscope group were(18.95±3.24)ml/s and(19.41±4.36)points,respectively,which were higher than those in the conventional surgery group(16.36±3.85)ml/s and(16.59±4.77)points,and the residual urine volume(RUV)was(26.82±4.22)ml,which was lower than that in the conventional surgery group(30.28±4.56)ml,with statistically significant differences(Fvalues were 5.270,5.340and 6.356,Pvalues were 0.007,0.007and 0.003,respectively).The total incidence of complications in the ureteroscope group(10.26%)was lower than that in the conventional surgery group(28.21%),the difference was statistically significant(χ^(2)=4.404,P=0.044).Conclusion Urethral realignment under ureteroscope for male patients with closed UI can improve perioperative indexes and inflammatory state of the body,effectively relieve postoperative pain,improve urination,and improve erectile function of the patients,and have high safety.