CAJ | 학술논문

目的探讨新型尿道拖入术对后尿道狭窄的治疗效果.方法入选我院2001年9月至2010年12月入院手术的后尿道狭窄患者129例(均为骨盆骨折所致；狭窄长度1.5～5.3 cm;53例为曾在外院经历过至少1次尿道狭窄手术失败的患者).采用对传统的尿道拖入术(Badenoch 手术)进行二次改良后的手术方式进行治疗.第一阶段(2001年9月至2008年1月)改良内容包括:(1)将远端尿道贯穿缝扎于一气囊导尿管上；(2)以导尿管的气囊作牵引,远端尿道被固定于近端尿道内、并且使两断端套叠1.5 cm;(3)于手术3周后开始,试着将导尿管向膀胱方向推移,待尿道残端坏死、脱落、导尿管与尿道分离后,拔除尿管.第二阶段(2008年2月至2010年12月)改良内容为:在上述基础上,改用带有冲洗功能的导尿管,术后以呋喃西林液冲洗尿道,3次/d.所有患者均随访6个月以上,如患者无自觉排尿困难、最大尿流率(Qmax)＞ 15 ml/s,则视为治疗成功.记录各种并发症.结果第一阶段共96例患者(102次)接受该手术,88例治疗成功(成功率92％)；8例于拔除导尿管1～13 d后尿道狭窄复发,再次膀胱造瘘3～11个月后再次手术(其中3例是在“第二阶段”内进行手术),均治疗成功.第二阶段共33例患者(36次)接受该手术,1例失败(成功率97％).所有病例实际随访时间为7～93个月(平均37.6个月)；手术6个月后Qmax(22±5)ml/s.3年以上的随访率51.1％.无尿失禁、勃起痛、尿道短缩等并发症.结论与Badenoch手术相比,经过我们二次改良后的新型尿道拖入术治疗后尿道狭窄,具有手术方法更加简单、成功率高、并发症少的特点；该新型尿道拖入术尤其适用于复杂的后尿道狭窄.
목적 탐토신형뇨도타입술대후뇨도협착적치료효과.방법 입선아원2001년9월지2010년12월입원수술적후뇨도협착환자129례(균위골분골절소치；협착장도1.5～5.3 cm;53례위증재외원경력과지소1차뇨도협착수술실패적환자).채용대전통적뇨도타입술(Badenoch 수술)진행이차개량후적수술방식진행치료.제일계단(2001년9월지2008년1월)개량내용포괄:(1)장원단뇨도관천봉찰우일기낭도뇨관상；(2)이도뇨관적기낭작견인,원단뇨도피고정우근단뇨도내、병차사량단단투첩1.5 cm;(3)우수술3주후개시,시착장도뇨관향방광방향추이,대뇨도잔단배사、탈락、도뇨관여뇨도분리후,발제뇨관.제이계단(2008년2월지2010년12월)개량내용위:재상술기출상,개용대유충세공능적도뇨관,술후이부남서림액충세뇨도,3차/d.소유환자균수방6개월이상,여환자무자각배뇨곤난、최대뇨류솔(Qmax)＞ 15 ml/s,칙시위치료성공.기록각충병발증.결과 제일계단공96례환자(102차)접수해수술,88례치료성공(성공솔92％)；8례우발제도뇨관1～13 d후뇨도협착복발,재차방광조루3～11개월후재차수술(기중3례시재“제이계단”내진행수술),균치료성공.제이계단공33례환자(36차)접수해수술,1례실패(성공솔97％).소유병례실제수방시간위7～93개월(평균37.6개월)；수술6개월후Qmax(22±5)ml/s.3년이상적수방솔51.1％.무뇨실금、발기통、뇨도단축등병발증.결론 여Badenoch수술상비,경과아문이차개량후적신형뇨도타입술치료후뇨도협착,구유수술방법경가간단、성공솔고、병발증소적특점；해신형뇨도타입술우기괄용우복잡적후뇨도협착.
Objective To determine the effects of modified pull-through operation(Badenoch operation)on the treatment of posterior urethral stricture.Methods From September 2001 to December 2010 traditional pull-through operation was Modified for two times in our center.A total of 129 patients with posttraumatic posterior urethral stricture resulting from pelvic fracture injury underwent the modified urethral pull-through operation.Stricture length was 1.5 to 5.3 cm(mean 2.9 cm).Of the patients 43 had undergone at least 1 previous failed management for stricture.In phase 1(from September 2001 to January 2008),the improving items include:(1)The distal urethral end was stitched and tied to the catheter.(2)As catheter was inserted into bladder and 20 ml water was injected into catheter balloon,the distal urethral end was fixed in the proximal urethra and an overlaying of 1.5 cm was formed between the two ends.(3)Three weeks later,it was tried to insert the catheter to bladder.After the urethral stump necrosis and the catheter separating from the urethra,the catheter was removed.In phase 2(from February 2008 to December 2010),based on the above,irrigating catheter was used.After the surgery,urethra was irrigated with 0.02％ furacillin solution through the catheter 3 times a day.All patients were followed up for at least 6 months.If patients had no conscious dysuria and maximum urinary flow rate(Qmax)＞ 15 ml/s,the treatment was considered successful.All complications were recorded.Results In phase 1,the 96 patients (101 times)underwent the procedure.The treatment was successful in 88 patients(success rate 92％).Within 1 to 13 days after removal of the catheter,urethral stricture was recurred in 8 patients.They had to undergo cystostomy once more for 3 to 11 months before reoperation(the 3 patients' reoperation was in phase 2).The 8 cases were treated successfully.In phase 2,33 patients(total 36 times)underwent the procedure.One patient was failed(success rate 97％).The actual follow-up time is 7 to 93 months(An average of 37.6 months).Qmax is(22 ± 5)ml/s.No complications such as urinary incontinence,erectile pain,urinary shortening happened.Conclusions The modified urethral pull-through operation is effective for the surgical treatment of posttraumatic posterior urethral stricture.It has a high success rate with durable long-term results.Complications are few.The procedure is simple,less demanding and especially suitable in patients who had previously undergone failed surgical treatments.