经耻骨下缘切除途径修复复杂性长段后尿道狭窄或闭锁(附154例报告)  

Reconstruction of Complicated Posterior Urethrostenosis and Urethratresia with the Way to the Inferior Pubic Synthysis(Report of 154 Cases)

作　　者：傅强[1] 张炯[1] 撒应龙[1] 吴登龙[1] 乔勇[1] 金三宝[1] 徐月敏[1] 

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海200233

出　　处：《临床泌尿外科杂志》2009年第6期451-452,共2页Journal of Clinical Urology

摘　　要：目的:总结采用耻骨下缘切除途径治疗复杂性长段后尿道狭窄或闭锁的疗效。方法:自1997年1月～2007年12月对154例外伤导致长段后尿道狭窄或闭锁(3.5～7.0 cm)患者采用经耻骨下缘切除途径行尿道修复术,其中32例并发尿道直肠瘘或尿道皮肤瘘。具体方法是取会阴部正中切口,切除狭窄或闭锁段尿道及瘢痕组织,分离远近端尿道至正常的尿道,切开部分阴茎海绵体中隔,分离耻骨下缘间隙,用扁平凿凿去下部分骨块,将远端尿道穿过阴茎海绵体中隔或从一侧阴茎海绵体下方穿过,与前列腺部尿道吻合。结果:本组患者于术后3～4周拔出导尿管,127例排尿通畅,术后尿流率检查示最大尿流率为15.70～32.60 ml/s,平均21.94 ml/s;15例排尿困难,经尿道扩张后改善;余12例效果不佳。结论:耻骨下半部分切除能较好显露后尿道并缩短尿道吻合行程距离约3～5 cm,使尿道端端吻合容易化。Objective：To summarize effect of the reconstruction of complicated posterior urethrostenosis and urethratresia with the way to the inferior pubic synthysis. Methods：From Jan. 1997 to Dec. 2006, 154 cases with posterior urethrostenosis and urethratresia （3.5-7. 0 cm）due to trauma were performed reconstruction with the way to the inferior pubic synthysis. 32 cases were complicated by urinary rectal fistula or urethral Skin fistula. The specific method： the median perineal incision was taken. Urethral straitness or atresia paragraph and scar tissue were resected. Distal and proximal urethral were separated to normal urethral. The part of the septal of corpus cavernosum were sliced off. The gap of the inferior pubic synthysis was separated. The lower part of bone was chiseled with flat chisel, The distal urethral was taken through the the septum of corpus cavernosum, or through the bottom of one side of the corpus cavernosum, and to coincide the urethral in prostate. Results： ALL catheter of the patients were pull off in the 3-4 weeks after surgery. 127 cases were with unobstructed voiding. The postoperative maximum urinary flow rate ranged from 15.70-32.60 ml/s, with mean 21.94 ml/s. 15 cases were treated with dilatation due to difficult voiding postoperatively. The remaining 12 cases were with ineffective. Conclusions： The distance that the suprapubic lower part resection carl better revealed posterior urethral and shorten the distance of urethral anastomosis was 3-5 cm. It can be easy to make end-to-end urethral anastomosis.

关 键 词：尿道狭窄 耻骨下缘途径 尿道成形术 

分 类 号：R693.2[医药卫生—泌尿科学]