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目的:调查会阴部造瘘分期尿道成形术对超长段尿道狭窄的治疗效果,并评估手术对患者生活质量的影响。方法:回顾性调查2000～2010年间收治的54例超长段尿道狭窄患者(平均年龄40岁,狭窄长度平均6.5 cm)接受分期会阴部造瘘尿道成形手术疗效;并通过问卷调查的形式对其术后生活质量进行评估。疗效评估方式包括对排尿困难相关症状评分(IPSS)、自由尿流率、是否需要尿道扩张及患者主观对手术效果满意度。结果:54例患者会阴部造瘘术后最大尿流率为(14.0±4.7)ml/min,其中34例接受二期手术的患者中22例患者(64.7%)排尿通畅,最大尿流率为(12.0±3.5)ml/min,8例(23.5%)需定期尿道扩张,4例(11.8%)因吻合口再狭窄接受尿道内切开术。会阴部一期造瘘术后和二期术后IPSS评分分别为(5.4±2.1)分和(8.5±5.8)分,较术前[(27.3±24.5)分]有明显差异(P<0.01),术后生活质量满意度总体为92.6%(会阴部造瘘术)和64.7%(二期手术)。结论:会阴部造瘘+分期尿道成形术安全有效,术后患者满意度及生活质量较高,是治疗超长段尿道狭窄较为理想的手术方式。
OBJECTIVE: To investigate the effect of urethroplasty by perineal ostomy on the length of urethral stricture and to evaluate the effect of surgery on the quality of life of patients. Methods: A retrospective study of 54 patients with ulnar urethral stenosis (mean age 40 years, mean length of stenosis 6.5 cm) admitted to our hospital from 2000 to 2010 underwent urethroplasty with staged perineal ostomy was performed. The questionnaire Postoperative quality of life was assessed. Efficacy assessment methods included assessment of dyspepsia-related symptoms (IPSS), free flow of urine, need for urethral dilatation, and patient satisfaction with the subjective effect of the procedure. Results: The maximum urinary flow rate was 14.0 ± 4.7 ml / min after perineal fistula surgery in 54 patients. Twenty-four patients (64.7%) in 34 patients undergoing second-stage operation had voiding and urination. The maximum uroflow rate was (12.0 ± 3.5) ml / min, 8 cases (23.5%) required regular urethral dilatation, and 4 cases (11.8%) received urethral incision due to anastomotic restenosis. The IPSS scores of the perineal primary ostomy and postoperative second stage were (5.4 ± 2.1) and (8.5 ± 5.8) points respectively, which were significantly different from those of preoperative (27.3 ± 24.5) points (P0.01) Satisfaction with postoperative quality of life was 92.6% (perineal fistula) and 64.7% (second stage surgery). Conclusions: Perineal ostomy + staging urethroplasty is safe and effective, and postoperative satisfaction and quality of life are high. It is an ideal surgical method for the treatment of long urethral stricture.