男性创伤性复杂性后尿道狭窄的手术治疗  

Surgical treatment of post-traumatic complex posterior urethral stricture in male patients

作　　者：沈文浩[1] 张恒[1] 李新[1] 鄢俊安[1] 李为兵[1] 卢根生[1] 陈志文[1] 周占松[1] 宋波[1] 金锡御[1] 熊恩庆[1] 

机构地区：[1]第三军医大学附属西南医院全军泌尿外科研究所,重庆400038

出　　处：《中华创伤杂志》2011年第10期933-936,共4页Chinese Journal of Trauma

摘　　要：目的探讨男性创伤性复杂性后尿道狭窄的手术治疗效果。方法回顾性分析479例诊断为创伤性复杂性后尿道狭窄患者的临床资料。其中422例Ⅰ期行尿道狭窄段切除＋端端吻合术，57例行带血管蒂阴囊皮瓣后尿道成形术。结果手术时间平均115min（90～140rain），术中平均出血量225ml（100～300m1）。无一例需术中输血。术后平均随访15个月（12～24个月），422例行尿道吻合术的患者中，386例排尿通畅，36例排尿不畅的患者中，再次行排泄性尿道造影提示2l例是因为吻合口瓣膜形成，15例因局部存在狭窄环，行尿道瓣膜切除或狭窄环内切开术，术后恢复良好。57例行后尿道成形术患者中，45例排尿通畅；9例患者出现前尿道与皮管吻合口狭窄，其中4例行尿道扩张后好转，5例行尿道狭窄内切开术后好转；3例出现皮管与后尿道或膀胱颈吻合口狭窄，其中1例经尿道扩张后好转，2例行尿道狭窄内切开术后好转。结论Ⅰ期尿道狭窄段切除＋端端吻合术是治疗创伤性复杂性后尿道狭窄的主要方法，病情不允许时可行后尿道成形术。Objective To investigate the therapeutic effect of post-traumatic complex posterior urethral stricture in the male patients. Methods Clinical data of 479 male patients with post-traumatic complex posterior urethral stricture were reviewed. One-stage resection of the stenosis and end-to-end anastomosis was performed in 422 patients and scrotal flap with blood pedicle posterior urethroplasty in 57. Results The mean operation time was 115 minutes （range, 90-140 minutes）. The mean blood loss was 225 ml （range, 100-300 ml）. No intraoperative blood transfusion was needed. The mean follow-up time was 15 months （range, 12-24 months）. Among the 422 patients performed end-to-end anastomosis, 386 patients had good voiding and 36 had dysuria because of the formation of anastomotic stoma valve （21 patients ） or stricture ring （15 patients）. The problem was resolved by transurethral valve/stricture ring resection. Among 57 patients undergone posterior urethroplasty, 45 patients had good voiding nine patients were found with anterior urethra-skin tube anastomotic stoma stricture, of which four patients were treated by urethral dilatation and five by endourethrotomy; three patients were found with posterior urethra-skin tube anastomotic stoma stricture, of which one patient was treated by urethral dilation and two by endoure- throtomy. Conclusions One-stage resection of the stenosis and end-to-end anastomosis is the main treatment for post-traumatic complex posterior urethral stricture. If the condition of the patients does not allow the end-to-end anastomosis, posterior urethroplasty can be an alternative.

关 键 词：男性 创伤 后尿道狭窄 手术 

分 类 号：R699[医药卫生—泌尿科学]