Objective To compare and assess the efficacy of ventral/dorsal onlay graft urethroplasty in the treatment of urethral stricture. Methods We searched pertinent English literature via MEDLINE (1966 to 2007), EMBASE (1977 to 2007) and The Cochrane Library (Issue 4, 2007) for the use of ventral/dorsal graft urethroplasty in the reconstruction of urethral defect associated with urethral stricture. Data were extracted by two reviewers independently and analyzed by SPSS 13.0 software. Results A total of 50 studies involving 1 264 patients were included. Ventral onlay graft urethroplasty was used in 751 patients with a success rate of 82.6%, while dorsal onlay graft urethroplasty was used in 513 patients with a success rate of 86.9% (ventral vs. dorsal, χ2=4.432, P=0.035). Oral mucosa graft had the highest success rate (88.1%) of all grafts, and the success rate of free skin graft onlay urethroplasty was associated with the location of graft placement (ventral vs. dorsal, P=0.016). Concerning the location of stricture, urethroplasty for bulbar urethral stricture achieved the best results, with a success rate of 87.7%, which was also associated with the location of graft placement (ventral vs. dorsal, P=0.025). Conclusion Dorsal onlay graft urethroplasty is better than ventral onlay. It is better to place the free skin graft in the dorsal part of urethra. Bulbar urethral stricture is more suitable for graft onlay urethroplasty than penile urethral stricture.
目的 探讨不典型肾结核诊断与治疗。 方法 回顾性分析2003年1月－2010年7月12例肾结核住院患者的临床资料。患者尿常规异常9例（75%）；腰痛3例（25%）；尿频8例（66.7%）。尿沉渣检查抗酸杆菌9例中阳性2例（22.2%）；静脉尿路造影11例，患肾不显影7例（63.6%），提示肾结核2例(18.2%)；逆行尿路造影7例，提示肾结核1例（14. 3%）；CT确诊8例（66.7%）。确诊肾结核后，12例患者中7例行手术治疗，5例行药物治疗。药物治疗患者中3例采用异烟肼、利福平加盐酸乙胺丁醇治疗，疗程为9个月；2例加用吡嗪酰胺，疗程为1年。手术治疗7例患者于抗结核治疗2周后行肾切除术，术后行抗结核治疗1～1.5年。治疗结束后随访尿查结核分枝杆菌6个月。 结果 异烟肼、利福平加盐酸乙胺丁醇药物治疗组3例中1例在9个月后复查时患肾损伤严重，行肾切除，另2例患者以及加用比嗪酰胺2例药物抗结核治疗后，活动性病灶消失，连续半年尿中未找见结核分枝杆菌。行肾切除手术的7例患者术中2例肾萎缩，5例患肾体积增大，均伴有不同程度肾积脓；肾切除术后病理均确诊为肾结核，合并输尿管结核2例，输尿管慢性炎症4例。7例手术患者术后行抗结核治疗，治疗结束后尿中均未找见结核分枝杆菌，影像学检查也未发现新发病灶。 结论 临床症状不典型及起病隐匿是导致肾结核延误诊疗的重要原因。彩色多普勒超声、静脉肾盂造影、逆行尿路造影是主要的检查方法，CT对肾结核的诊断具有重要价值。手术治疗上多以患肾切除为主。