基于倾向性匹配评分分析改良舌黏膜尿道重建术治疗尿道狭窄临床疗效

Clinical efficacy of modified lingual mucosal urethral reconstruction in the treatment of urethral stricture based on propensity score matching

目的探讨改良舌黏膜尿道重建术治疗尿道狭窄(US)临床疗效。方法收集2019年1月至2024年2月期间湘雅常德医院收治的112例男性US患者通过采用舌黏膜移植物或带蒂阴茎皮瓣两种不同术式治疗的临床相关资料,按照不同移植物尿道重建术分为观察组(52例,舌黏膜尿道重建术)和对照组(60例,阴茎皮瓣尿道重建术),用倾向性匹配评分(PSM)进行两组间1∶1匹配,最终41对数据成功匹配。所有患者术后均随访1年,比较两组不同时间点的最大尿流率、国际勃起功能指数(IIEF-5)评分、手术成功率、复发率及并发症发生率。计量资料比较采用独立样本t检验,计数资料比较采用χ^(2)检验。结果观察组和对照组的最大尿流率分别为术后拔管时(22.3±3.6)、(21.8±3.7)ml/s(t=0.620,P>0.05),术后1个月(20.1±4.2)、(19.9±4.4)ml/s(t=0.210,P>0.05),术后3个月(19.3±3.6)、(18.9±3.8)ml/s(t=0.383,P>0.05),术后6个月(17.7±2.4)、(17.5±2.5)ml/s(t=0.487,P>0.05),术后1年(16.4±1.9)、(15.8±1.9)ml/s(t=1.473,P>0.05);手术成功率分别为97.6%(40/41)和92.7%(38/41)(χ^(2)=1.051,P>0.05);复发率分别为2.4%(1/41)和9.8%(4/41)(χ^(2)=1.917,P>0.05);术后并发症总发生率分别为7.3%(3/41)和12.2%(5/41)(P>0.05);术后IIEF-5评分分别为(15.9±3.4)、(14.0±3.5)分(t=2.542,P<0.05)。结论舌黏膜应用于尿道重建术中治疗US患者的疗效良好,可有效改善排尿功能和主观排尿症状,对其性功能影响较小,复发率较低,且相较于阴茎皮瓣,舌黏膜取材简便,适用范围广。

Objective To investigate the clinical efficacy of modified lingual mucosal urethral reconstruction in the treatment of urethral stricture(US).Methods The clinical data of 112 male patients with urethral stricture treated in Xiangya Changde Hospital from January 2019 to February 2024 were retrospectively collected by using tongue mucosa graft or pedicled penile flap.According to different graft urethral reconstructions,the patients were divided into observation group(n=52,lingual mucosal urethral reconstruction)and control group(n=60,penile flap urethral reconstruction).The propensity score matching(PSM)was used for 1∶1 matching between the two groups.Finally,41 pairs of data were successfully matched.All patients were followed up for 1 year after operation.The maximum urinary flow rate at different time points,international index of erectile function 5(IIEF-5),success rate,recurrence rate and complication rate of operation were compared between the two groups.Independent sample t test was used for measurement data comparison,andχ^(2)test was used for counting data comparison.Results In observation group and control group,the maximum urinary flow rate was(22.3±3.6)ml/s and(21.8±3.7)ml/s(t=0.620,P>0.05)at extubation after operation,(20.1±4.2)ml/s and(19.9±4.4)ml/s(t=0.210,P>0.05)at 1 month after operation,(19.3±3.6)ml/s and(18.9±3.8)ml/s(t=0.383,P>0.05)at 3rd month after operation,(17.7±2.4)ml/s and(17.5±2.5)ml/s(t=0.487,P>0.05)at 6th month after operation,(16.4±1.9)ml/s and(15.8±1.9)ml/s(t=1.473,P>0.05)at 1st year after operation,success rate of operation was 97.6%(40/41)and 92.7%(38/41)(χ^(2)=1.051,P>0.05),recurrence rates were 2.4%(1/41)and 9.8%(4/41)(χ^(2)=1.917,P>0.05),total incidence of postoperative complications was 7.3%(3/41)and 12.2%(5/41)(P>0.05),and postoperative IIEF-5 scores were(15.9±3.4)and(14.0±3.5)(t=2.542,P<0.05),respectively.Conclusion Tongue mucosa is effective in the treatment of patients with US during urethral reconstruction.It can effectively improve urination function and subjective urination symptoms.It has little effect on sexual function and low recurrence rate.Compared with penile flap,tongue mucosa is easy to draw and has a wide range of application.