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目的:总结人工尿道括约肌(AUS)植入用于治疗尿道外伤后尿失禁的经验。方法:回顾性分析我中心2002年4月~2015年12月收治的17例尿道外伤后尿失禁行AUS植入的患者临床资料。患者平均年龄40.29岁,男16例,女1例。其中骨盆骨折尿道断裂患者16例,骑跨伤导致尿道断裂1例。术前作为尿道重建手术的一部分,其中3例行尿道括约肌切断术,5例行尿道扩张术,2例行尿道狭窄切开术。对前期尿道修复手术准备、括约肌植入术后并发症处理及患者尿失禁和生活质量改善情况进行观察评价。结果:17例患者中术后1个月均成功激活装置并正常使用,14例患者能达到社交控尿水平(每日使用尿垫2片及以下),其中8例患者可达到完全干燥,总体手术成功率达到82.3%(14/17)。患者尿垫使用量显著下降(术前3.62±0.35片/d,术后1.29±0.31片/d,P<0.01);尿失禁影响生活质量评分(VAS)显著改善(术前6.75±0.36,术后1.86±0.63,P<0.01)。术后并发症发生率为23.5%,其中感染1例,局部溶蚀2例,机械故障1例。平均随访时间40.8(13~144)个月。截止最近一次随访,13例患者仍然使用初次安装的括约肌装置,2例患者行一次修复手术,2例患者因术后并发症取出装置。结论:尿道外伤后尿失禁的治疗需根据患者个体情况制定手术方案。AUS植入作为一系列尿路重建手术中的重要步骤,是安全、有效的。
Objective: To summarize the experience of using artificial urethral sphincter (AUS) for urinary incontinence after urethral trauma. Methods: The clinical data of 17 AUS patients with urinary incontinence underwent urethral trauma in our center from April 2002 to December 2015 were retrospectively analyzed. The average age of patients 40.29 years old, 16 males and 1 female. Among them, 16 cases of pelvic fracture and urethral rupture and 1 case of urethral rupture caused by riding injury. Preoperative urethral reconstruction as part of surgery, of which 3 cases of urethral sphincterotomy, urethral dilation in 5 cases, 2 cases of urethral stricture incision. Preoperative urethral repair preparation, surgical treatment of sphincter implantation and patients with urinary incontinence and quality of life were observed and evaluated. RESULTS: All 17 patients were successfully activated and operated normally 1 month after operation. Fourteen patients achieved the level of social control of urine (2 tablets per day and below), of which 8 patients achieved complete dryness. Overall, Surgical success rate reached 82.3% (14/17). The amount of urinary pad decreased significantly (preoperative 3.62 ± 0.35 / d, postoperative 1.29 ± 0.31 / d, P <0.01); urinary incontinence had a significant improvement on VAS (preoperative 6.75 ± 0.36, After 1.86 ± 0.63, P <0.01). The incidence of postoperative complications was 23.5%, including 1 case of infection, 2 cases of local erosion and 1 case of mechanical failure. The average follow-up time was 40.8 (13 ~ 144) months. As of the most recent follow-up, 13 patients were still using their initial sphincter device, 2 had a single repair operation, and 2 had their device removed for postoperative complications. Conclusion: The treatment of urinary incontinence after urethral trauma needs to make the surgical plan according to the patient’s individual circumstances. AUS implantation is a safe and effective procedure as an important step in a series of urothelial reconstructive procedures.