摘要目的 探讨女性尿道憩室的临床特征及诊断和治疗方法.方法 回顾性分析2005年6月至2016年6月我院收治的56例女性尿道憩室患者的临床资料.年龄34～ 63岁,平均43.6岁.根据患者MRI检查表现不同分为单纯型憩室(尿道外周单个囊状影)和复杂型憩室(包绕尿道＞50％的U型或环绕型).单纯型憩室32例,年龄34 ～ 56岁,平均42.1岁;憩室均位于尿道远端,平均直径2.5 cm;复杂型憩室24例,年龄42～ 63岁,平均45.7岁;病变位于尿道近端8例,尿道远端16例,平均直径3.1 cm.单纯型憩室中反复尿路感染23例(71.8％),盆腔坠胀22例(68.7％),排尿后滴沥19例(59.4％);复杂型憩室的上述症状分别为22例(91.7％)、23例(95.8％)、21例(84.5％),两组比较差异有统计学意义(均P＜0.05).单纯型憩室的尿频和尿急、尿失禁、性交疼痛、排尿困难症状分别为22例(68.7％)、18例(56.2％)、5例(15.6％)、3例(9.4％),复杂型憩室的上述症状分别为18例(75.0％)、16例(66.7％)、4例(16.6％)、1例(4.2％),两组比较差异无统计学意义(均P＞0.05).49例患者接受经阴道前壁的病变切除及创面多层关闭,7例尿道损伤严重及周围组织缺乏的复杂型病例联合阴唇下脂肪瓣填入治疗.分析不同类型憩室术前及术后1个月临床症状的阳性率情况及手术治疗效果.结果 56例手术均顺利完成,术后随访时间6～48个月,平均14.2个月.两组术后1个月的尿路感染、盆腔坠胀、排尿后滴沥、尿失禁、性交疼痛及排尿困难症状阳性率与术前比较差异有统计学意义(均P ＜0.05),但尿频、尿急症状与术前比较差异无统计学意义(P＞0.05).复杂型和单纯型憩室术后出现反复尿路感染(16.6％与21.8％)、盆腔坠胀(12.5％与9.4％)、排尿后滴沥(25.0％与15.6％)、尿频和尿急(58.3％与53.1％)、尿失禁(12.5％与9.4％)、性交疼痛(8.3％与6.2％)的患者比例比较差异无统计学意义(均P＞0.05).随访期间有3例(12.5％)复杂型憩室复发,经再次手术治愈.结论 对久治不愈的尿路感染、盆腔疼痛及排尿后滴沥等症状的女性患者,应考虑尿道憩室的可能.MRI检查可明确诊断并分型.经阴道前壁的憩室完全切除可以取得较好的治疗效果.

abstractsObjective To investigate the presentation,diagnosis and surgical treatment of female urethral diverticulum.Methods From June 2005 to June 2016,56 female patients with urethral diverticulum were treated in our department.The presenting symptoms,clinical characteristics and surgical outcomes were reviewed.Mean age was 43.6 years (range 34 to 63).Patients were classified as simple and complex diverticulum (extend partially around the urethra ＞ 50％,U-shaped or circumferential) according to MRI features.Thirty-two patients hadsimple diverticulum locating in distal urethra with a mean age of 42.1 years,and 24 patients had complex diverticulum locating in proximal (8 cases) or distal urethra (16 cases) with a mean age of 45.7 years.The average diameter of the diverticulum was 2.5cm and 3.1cm respectively.There were 23 cases (71.8％) with recurrent urinary tract infection,22(68.7％) with pelvic pain,19(59.4％) with postvoid dribbling in simple diverticulum and 22 (91.7％),23 (95.8％),21 (84.5％) in complex diverticulum respectively.Patients with complex diverticulum were more likely to present with these symptoms than simple diverticulum(P ＜ 0.05).The statistical differences in preoperative frequency and urgency(68.7％ vs.75.0％),urinary incontinence(56.2％ vs.66.7％),dyspareunia(15.6％ vs.16.6％) and dysuria(9.4％ vs.4.2％) were not found between simple and complex groups.Transvaginal diverticulectomy and multiple layers closures were performed in 49 patients.A Martius flap interposition was used in 7 complex cases with severe urethral damage and insufficient periurethral fascia.Presenting symptoms and surgical outcomes were assessed according to different types of diverticulum.Results Fifty-six operations were completed successfully.The mean follow-up was 14.2 months (range 6-48 months).Recurrent urinary tract infection,pelvic pain,postvoid dribbling,urinary incontinence,dyspareunia and dysuria improved after surgery in both groups.There were statistical differences in symptom improvement before and after surgery (P ＜ 0.05) except for frequency and urgency.Postoperative symptoms in patients with complex and simple diverticulum were recurrent urinary tract infection (16.6％ vs.21.8％),pelvic pain (12.5％ vs.9.4％),postvoid dribbling (25.0％ vs.15.6％),frequency and urgency(58.3％ vs.53.1％),urinary incontinence(12.5％ vs.9.4％),dyspareunia(8.3％ vs.6.2％).There were no statistically significant differences between the postoperative symptoms of complex and simple diverticulum (P ＞ 0.05).Three(12.5％) cases of complex diverticulum recuredand cured after a following surgery.Conclusions For female patients with recurrent urinary tract infection,pelvic pain,postvoid dribbling and vaginal mass,the possibility of urethral diverticulum should be considered.MRI is an excellent imaging method for urethral diverticulum dignosis and classification.Transvaginal complete diverticulectomy,multiple layers closures are feasible and effective treatments.