中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
4期
307-310
,共4页
尿道骑跨伤%输尿管镜%尿道会师术%尿道修补吻合术
尿道騎跨傷%輸尿管鏡%尿道會師術%尿道脩補吻閤術
뇨도기과상%수뇨관경%뇨도회사술%뇨도수보문합술
Urethral straddle injury%Ureteroscope%Urethral realignment%Urethral anastomosis
目的：研究急诊输尿管镜下尿道会师术治疗尿道骑跨伤的疗效与安全性。方法回顾性分析山东省滕州市中心人民医院2007年8月至2013年8月收治的放置导尿管失败的尿道骑跨伤患者39例的临床资料，按手术方式不同分为两组。尿道修补吻合术组（A组，27例）选择一期经会阴尿道修补吻合术；输尿管镜下尿道会师术组（B组，12例）采用输尿管镜下引导放置导尿管。比较两组在手术时间、术中失血量、并发症（尿道狭窄、勃起障碍）发生率、住院时间的差异。同时检索PubMed/MEDLINE、EMBASE、万方数据库、中国知网CNKI、维普数据库、中国优秀硕士/博士学位论文数据库2000年至2013年发表的有关急诊尿道会师术治疗尿道损伤的相关文献，采用Revman 5.2软件进行荟萃分析（Meta分析）。结果与A组比较，B组手术时间及术后住院时间均明显缩短〔手术时间（min）：26±15比71±18，住院时间（d）：2.6±1.2比5.2±1.9，均P＜0.05〕，术中失血量、勃起障碍发生率均明显降低〔术中失血量（mL）：21±10比52±19，勃起障碍发生率：0（0/12）比14.8%（4/27），均P＜0.05〕，尿道狭窄发生率比较差异无统计学意义〔8.3%（1/12）比0（0/27），P＞0.05〕。尿道狭窄患者术后经尿道扩张并随访6～12个月，其中1例尿道扩张无效改用开放手术。检索相关文献进行Meta分析显示，最终有4个研究纳入Meta分析，尿道会师术比尿道吻合术治疗尿道损伤更有效〔优势比（OR）＝2.30，95%可信区间（95%CI）为1.07～4.95，P＝0.03〕。结论输尿管镜下尿道会师术是治疗尿道骑跨伤的较好术式，具有手术时间短、创伤小、术后恢复快、并发症少等优点。
目的：研究急診輸尿管鏡下尿道會師術治療尿道騎跨傷的療效與安全性。方法迴顧性分析山東省滕州市中心人民醫院2007年8月至2013年8月收治的放置導尿管失敗的尿道騎跨傷患者39例的臨床資料，按手術方式不同分為兩組。尿道脩補吻閤術組（A組，27例）選擇一期經會陰尿道脩補吻閤術；輸尿管鏡下尿道會師術組（B組，12例）採用輸尿管鏡下引導放置導尿管。比較兩組在手術時間、術中失血量、併髮癥（尿道狹窄、勃起障礙）髮生率、住院時間的差異。同時檢索PubMed/MEDLINE、EMBASE、萬方數據庫、中國知網CNKI、維普數據庫、中國優秀碩士/博士學位論文數據庫2000年至2013年髮錶的有關急診尿道會師術治療尿道損傷的相關文獻，採用Revman 5.2軟件進行薈萃分析（Meta分析）。結果與A組比較，B組手術時間及術後住院時間均明顯縮短〔手術時間（min）：26±15比71±18，住院時間（d）：2.6±1.2比5.2±1.9，均P＜0.05〕，術中失血量、勃起障礙髮生率均明顯降低〔術中失血量（mL）：21±10比52±19，勃起障礙髮生率：0（0/12）比14.8%（4/27），均P＜0.05〕，尿道狹窄髮生率比較差異無統計學意義〔8.3%（1/12）比0（0/27），P＞0.05〕。尿道狹窄患者術後經尿道擴張併隨訪6～12箇月，其中1例尿道擴張無效改用開放手術。檢索相關文獻進行Meta分析顯示，最終有4箇研究納入Meta分析，尿道會師術比尿道吻閤術治療尿道損傷更有效〔優勢比（OR）＝2.30，95%可信區間（95%CI）為1.07～4.95，P＝0.03〕。結論輸尿管鏡下尿道會師術是治療尿道騎跨傷的較好術式，具有手術時間短、創傷小、術後恢複快、併髮癥少等優點。
목적：연구급진수뇨관경하뇨도회사술치료뇨도기과상적료효여안전성。방법회고성분석산동성등주시중심인민의원2007년8월지2013년8월수치적방치도뇨관실패적뇨도기과상환자39례적림상자료，안수술방식불동분위량조。뇨도수보문합술조（A조，27례）선택일기경회음뇨도수보문합술；수뇨관경하뇨도회사술조（B조，12례）채용수뇨관경하인도방치도뇨관。비교량조재수술시간、술중실혈량、병발증（뇨도협착、발기장애）발생솔、주원시간적차이。동시검색PubMed/MEDLINE、EMBASE、만방수거고、중국지망CNKI、유보수거고、중국우수석사/박사학위논문수거고2000년지2013년발표적유관급진뇨도회사술치료뇨도손상적상관문헌，채용Revman 5.2연건진행회췌분석（Meta분석）。결과여A조비교，B조수술시간급술후주원시간균명현축단〔수술시간（min）：26±15비71±18，주원시간（d）：2.6±1.2비5.2±1.9，균P＜0.05〕，술중실혈량、발기장애발생솔균명현강저〔술중실혈량（mL）：21±10비52±19，발기장애발생솔：0（0/12）비14.8%（4/27），균P＜0.05〕，뇨도협착발생솔비교차이무통계학의의〔8.3%（1/12）비0（0/27），P＞0.05〕。뇨도협착환자술후경뇨도확장병수방6～12개월，기중1례뇨도확장무효개용개방수술。검색상관문헌진행Meta분석현시，최종유4개연구납입Meta분석，뇨도회사술비뇨도문합술치료뇨도손상경유효〔우세비（OR）＝2.30，95%가신구간（95%CI）위1.07～4.95，P＝0.03〕。결론수뇨관경하뇨도회사술시치료뇨도기과상적교호술식，구유수술시간단、창상소、술후회복쾌、병발증소등우점。
Objective To evaluate the effectiveness and safety of emergency realignment of urethra with straddle injury under the guidance of ureteroscope. Methods The clinical results of 39 patients with urethra straddle injury having the failure of inputting a urethral catheter from August 2007 to August 2013 in Central People's Hospital of Tengzhou City,Shandong province were retrospectively investigated,and according to the difference in method of operation,the patients were divided into two groups. In group A,there were 27 patients who underwent the first stage perineal urethra repair and anastomosis operation,and in group B,there were 12 patients who underwent urethral realignment operation and insertion of a catheter under the guidance of ureteroscope. The operation time, amount of bleeding in operation,incidence of complications such as urethral stricture,erectile dysfunction,as well as postoperative hospital stay were compared between the two groups. In addition,we searched PubMed/MEDLINE, EMBASE,Wanfang database,China journal full-text database(CNKI),VIP database and China outstanding master's/doctoral dissertation database from which we selected research literatures from 2000 to 2013 on emergency realignment of urethra with straddle injury and conducted Meta-analysis by Revman 5.2 software. Results Compared to group A, the operation time and postoperative hospital stay were significantly shortened in group B〔operation time(minutes):26±15 vs. 71±18,postoperative hospital stay(days):2.6±1.2 vs. 5.2±1.9,both P<0.05〕,amount of bleeding during operation and incidence of erectile dysfunction were markedly decreased in group B〔bleeding amount(mL):21±10 vs. 52±19,incidence of erectile dysfunction:0(0/12)vs. 14.8%(4/27),both P<0.05〕. However,the incidence of urethral stricture compared between the two groups had no statistical significant difference〔8.3%(1/12) vs. 0(0/27),P>0.05〕. And patients suffering from urethral stenosis were treated with postoperative transurethral expansion and followed up for 6 to 12 months,including 1 case of urethra expansion invalid to switch to open surgery. Related literatures were researched for Meta-analysis,and 4 literatures were enrolled. Meta-analysis results further confirmed that urethral realignment was more effective than urethral anastomosis for urethral injury〔odds ratio(OR)=2.30,95% confidence interval(95%CI)1.07 - 4.95,P=0.03〕. Conclusion Performing urethral realignment operation under the guidance of ureteroscopy is a better operation in the treatment of urethral straddle injury,having the advantages of shorter operation time,less trauma,quicker recovery and fewer complications.
