CAJ | 학술논문

目的总结直视下尿道内切开术(direct vision internal urethrotomy,DVIU)治疗尿道狭窄的经验.方法回顾性分析1990年6月至2010年6月20年间DVIU治疗尿道狭窄或闭锁患者361的临床资料.年龄16～72岁,平均38岁.病程3～78个月,平均16个月.狭窄或闭锁长度0.2～2.0 cm,平均1.1 cm.狭窄长度≤1.0 cm 238例,其中≤0.5 cm 63例(组1),0.6～1.0 cm 175例(组2),瘢痕厚度≤1.0 cm 148例,＞1.0 cm 90例;狭窄长度1.1～2.0 cm 123例,其中1.1～1.5cm 85例(组3),1.6～2.0 cm 38例(组4),瘢痕厚度≤1.0 cm 44例,＞1.0 cm 79例.结果 361例中手术失败3例.320例获随访,随访时间12～120个月,平均42个月.因狭窄复发而接受开放手术174例(54.4%),4组中转开放手术率分别为3.3%、49.7%、83.3%和97.1%.狭窄长度≤1.0cm者获随访207例,其中瘢痕厚度≤1.0 cm转开放手术27.2%(37/136),瘢痕厚度＞1.0 cm转开放手术60.6%(43/71).狭窄长度＞1.0 cm者获随访113例,其中瘢痕厚度≤1.0 cm转开放手术78.6%(33/42),瘢痕厚度＞1.0 cm转开放手术84.5%(60/71).结论当尿道狭窄长度≤0.5 cm时,DVIU术后转开放手术的比例明显减少;狭窄长度≤1.0 cm,瘢痕厚度≤1.0 cm者,DVIU也可获较好疗效.
목적 총결직시하뇨도내절개술(direct vision internal urethrotomy,DVIU)치료뇨도협착적경험.방법 회고성분석1990년6월지2010년6월20년간DVIU치료뇨도협착혹폐쇄환자361적림상자료.년령16～72세,평균38세.병정3～78개월,평균16개월.협착혹폐쇄장도0.2～2.0 cm,평균1.1 cm.협착장도≤1.0 cm 238례,기중≤0.5 cm 63례(조1),0.6～1.0 cm 175례(조2),반흔후도≤1.0 cm 148례,＞1.0 cm 90례;협착장도1.1～2.0 cm 123례,기중1.1～1.5cm 85례(조3),1.6～2.0 cm 38례(조4),반흔후도≤1.0 cm 44례,＞1.0 cm 79례.결과 361례중수술실패3례.320례획수방,수방시간12～120개월,평균42개월.인협착복발이접수개방수술174례(54.4%),4조중전개방수술솔분별위3.3%、49.7%、83.3%화97.1%.협착장도≤1.0cm자획수방207례,기중반흔후도≤1.0 cm전개방수술27.2%(37/136),반흔후도＞1.0 cm전개방수술60.6%(43/71).협착장도＞1.0 cm자획수방113례,기중반흔후도≤1.0 cm전개방수술78.6%(33/42),반흔후도＞1.0 cm전개방수술84.5%(60/71).결론 당뇨도협착장도≤0.5 cm시,DVIU술후전개방수술적비례명현감소;협착장도≤1.0 cm,반흔후도≤1.0 cm자,DVIU야가획교호료효.
Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy (DVIU).Methods The clinical data of 361 patients (age range 16 -72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively analyzed.The disease course ranged from three months to 78 months with a mean of 16 months.The stricture length ranged from 0.2 to 2.0 cm (mean 1.1 cm).Stricture length was split into four main groups:stricture length≤0.5 cm in 63 (group 1 ), stricture length ranging between 0.6 and 1.0 cm in 175 ( group 2), stricture length ranging between 1.0 and 1.5 cm in 85 ( group 3 ) , and stricture length ranging between 1.6 and 2.0 cm in 38 ( Group 4).Of the 238 patients with length less than 1.0 cm there were 148 who's scar thickness were less than 1.0 cm, and 90 who's scar thickness were greater than 1.0 cm.Of the 123 patients with length less than 2.0 cm there were 69 who's scar thickness was less than 1.0 cm, and 54 who's scar thickness was greater than 1.0 cm.Results Three patients with DVIU failed because of long occlusion and false passage.Three hundred and twenty patients were followed-up from 12 to 120 months (mean:42).Re-openiag procedures were performed on 174 patients (54.4%) due to recurrence.The re-openiag procedure rate was 3.3%, 49.7%, 83.3% and 97.1% in Group1, Group2,Group3 and Group4, respectively.On the basis of scar thickness, of the 207 patients with stricture length less than 1.0 cm, 38 of 136 patients (27.9%) with scar thickness less than 1.0 cm underwent opening operation, and 43 of 71 patients (60.6%) with scar thickness more than 1.0 cm underwent opening operation.One hundred and thirteen patients with stricture length more than 1.0 cm, 33 of 42 patients (78.6%) with scar thickness less than 1.0 cm underwent opening operation, and 60 of 71 patients (84.5%) with scar thickness more than 1.0 cm underwent opening operation.Conclusions Good efficacy can be achieved in patients whose urethral stricture length is less than 0.5cm or whose stricture length and scar thickness is less than 1.0 cm using DVIU.