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目的:研究尿道端端吻合术对外伤性尿道狭窄患者勃起功能的影响。方法:对41例采用尿道端端吻合术治疗的骨盆骨折导致尿道损伤(PFUDD)相关尿道狭窄患者手术前后两个阶段进行血管活性药物注射后阴茎血流彩色多普勒超声波(PPUD)检查和国际勃起功能指数-5(11EF-5)间卷调查,并对数据进行统计学分析。结果:所有41例患者手术前后的IIEF-5评分无显著差异,且勃起功能无明显变化者占大多数,约为56%。各年龄组、狭窄长度组及狭窄部位组患者手术前后的IIEF-5评分均无显著差异,但术后勃起功能提高组、不变组和降低组3组间的狭窄长度差异有统计学意义(2.16±1.49 vs 2.28±0.88 vs 3.50±1.53,P=0.0134),且差异主要存在于降低组与提高组或不变组之间(P=0.0129,0.0165)。轻度及中低度ED组患者术后IIEF-5评分出现明显下降(13.86±1.88 vs 11.43±3.37,P=0.0202),而中度及重度ED组患者则无明显变化。非血管性ED组患者手术前后的IIEF-5评分差异有统计学意义(14.88±1.81 vs 10.88±4.02,P=0.0103),动脉性和静脉性ED组患者手术前后评分则无明显差别。结论:尿道端端吻合术对PFIDD等外伤相关尿道狭窄患者的勃起功能没有显著影响,患者术后勃起功能的变化情况与狭窄长度、术前性功能状态等有关,而与患者年龄、狭窄部位等没有明确的关系。
Objective: To study the effect of urethral anastomosis on erectile function in traumatic urethral stricture. METHODS: Forty-one cases of pelvic fractures treated with urethral anastomosis resulted in penile blood flow color Doppler ultrasound (PPUD) examination before and after surgery in patients with urethral stricture (PFUDD) -associated urethral stricture and International Erectile function index -5 (11EF-5) inter-roll survey, and the data were statistically analyzed. Results: All 41 patients had no significant difference in IIEF-5 scores before and after surgery, and no significant change in erectile function accounted for the majority, about 56%. There were no significant differences in IIEF-5 scores between before and after surgery in all age groups, stenosis group and stenosis group, but there was significant difference in stenosis length between the three groups (erection improved group, invariant group and reduction group) 2.16 ± 1.49 vs 2.28 ± 0.88 vs 3.50 ± 1.53, P = 0.0134), and the difference mainly existed between the reduction group and the enhancement group or the invariant group (P = 0.0129, 0.0165). The postoperative IIEF-5 scores of patients with mild and moderate ED were significantly decreased (13.86 ± 1.88 vs 11.43 ± 3.37, P = 0.0202), while there was no significant change in patients with moderate and severe ED. The preoperative and postoperative IIEF-5 scores in patients with non-vascular ED were significantly different (14.88 ± 1.81 vs 10.88 ± 4.02, P = 0.0103). There was no significant difference in preoperative and postoperative scores between patients with arterial and venous ED. Conclusions: The urethral anastomosis has no significant effect on the erectile function of patients with urethral stricture such as PFIDD. The change of postoperative erectile function is related to the length of stenosis, preoperative sexual function, etc., but not with age, No clear relationship.