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目的:分析外伤性和前列腺术后尿道狭窄各种治疗方法的优缺点及影响因素,为临床上合理选择治疗方式、减少狭窄复发提出有益建议。方法:对本科64例外伤性和59例前列腺术后的尿道狭窄初次治疗共123例进行回顾性多因素分析。结果:64例外伤性尿道狭窄患者中,尿扩22例,20例(90.9%)复发;尿道内切开21例,16例(76.2%)复发;尿道端端吻合21例,4例(19%)复发;59例前列腺术后尿道狭窄中,尿扩16例,15例(93.6%)复发;尿道内切开37例,5例(13.5%)复发;6例切开膀胱行膀胱颈疤痕切开切除膀胱颈整形术,3例(50%)复发。结论:①经尿道疤痕切开切除治疗外伤性尿道狭窄,其疗效与狭窄长度有关,狭窄长度<2 cm复发率低,>2 cm则复发率高。②尿道疤痕切除端端吻合治疗外伤性尿道狭窄,其疗效与狭窄长度、狭窄部位、既往手术史无关,与手术本身有关,即术中如彻底切除狭窄疤痕及坏死组织、吻合无张力则复发率低,反之则高。③尿扩适用于尿道黏膜下狭窄,不适用于合并有尿道海绵体纤维化的尿道狭窄。④尿道内切开是治疗前列腺术后尿道狭窄的首选方法且疗效好。
OBJECTIVE: To analyze the advantages, disadvantages and influencing factors of various treatment methods of traumatic urethral stricture and prostatectomy, and to provide some beneficial suggestions for the rational choice of treatment and reduction of stenosis in clinic. Methods: A retrospective multivariate analysis was performed on 123 traumatic cases in our department and 59 cases of primary urethral stricture after prostatic surgery. Results: In 64 cases of traumatic urethral stricture, urinary expansion in 22 cases, 20 cases (90.9%) recurrence; urethral incision in 21 cases, 16 cases (76.2%) recurrence; urethral anastomosis in 21 cases, 4 cases %). Fifty-nine patients (93.6%) had recurrence of urethral stricture in 15 cases (93.6%) of urethral stricture after prostatectomy. 37 cases had urethral incision and 5 cases (13.5%) had recurrence of bladder urethral stricture. Open resection of bladder neck surgery, 3 cases (50%) recurrence. Conclusions: ① Transurethral scar excision for the treatment of traumatic urethral stricture is related to the stenosis length. The stenosis length is less than 2 cm, and the recurrence rate is higher than 2 cm. ② urethral scar resection end anastomosis treatment of traumatic urethral stricture, and its efficacy with the length of stenosis, stenosis, previous history has nothing to do with the operation itself, that is, such as complete resection of the scar and necrotic tissue, without recurrence of tension-free Low, otherwise high. ③ urinary expansion for the urethral submucosal stenosis, urethral sponge fibrosis is not suitable for urethral stricture. ④ urethral incision is the preferred method of treatment of postoperative urethral stricture and good effect.