改良尿道套入术在后尿道狭窄/闭锁治疗的应用  

Modified urethral pull-through procedure for posterior urethral stricture or atresia

作　　者：谢庆祥[1,2] 韩聪祥[1,2] 赵力[1,2] 黄宏伟[1,2] 林吓聪[1,2] 谢智明[1,2] 胡志[1,2] 朱显钟[1,2] 许伟杰[1,2] 

机构地区：[1]解放军第一七五医院 [2]厦门大学附属东南医院泌尿外科,福建漳州363000

出　　处：《中华男科学杂志》2011年第10期905-908,共4页National Journal of Andrology

摘　　要：目的:评估应用改良尿道套入术治疗后尿道狭窄/闭锁的可行性和安全性,提高手术治疗效果。方法:对应用改良尿道套入术治疗的212例后尿道狭窄/闭锁患者进行回顾性分析,狭窄闭锁段长度1.5～12 cm。66例曾有1～4次失败尿道手术史,208例经会阴或腹会阴切口、4例经会阴+切除部分耻骨下缘切口。15例应用游离包皮内板或/和膀胱粘膜进行尿道替代成形。结果:198例(93.4%)术后排尿满意,其中16例分别行尿道扩张3～15次后排尿正常,14例失败者,10例再次、2例3次手术成功、1例长期尿道扩张、1例长期留置膀胱造瘘管,15例应用尿道替代物成形者14例1次取得成功、1例术后19个月仍定期尿道扩张,所有患者无严重并发症。结论:改良尿道套入术治疗后尿道狭窄/闭锁是可行、安全的,具有创伤小、操作简便、成功率高等优点。尿道狭窄段>5 cm者应考虑应用尿道替代物成形。Objective： To evaluate the feasibility and safety of the modified urethral pull-through procedure for the treatment of posterior urethral stricture or atresia.Methods： We retrospectively analyzed 212 cases of posterior urethral stricture or atrasia treated by the modified urethral pull-through procedure.The length of the stricture or atrasia was 1.5-12 cm,and 66 cases had experienced 1-4 previous unsuccessful urethral repairs.Simple transperineal approach was adopted in 208 cases and transperineal-inferiorpubic approach in the other 4.And 15 of the patients underwent urethral construction with grafts.Results： Satisfactory voiding was achieved in 198（93.4%） of the patients,of whom 16 received 3-15 urethral dilations.Of the 14 cases that failed,10 succeeded after a second and 2 after a third operation.Of the 15 cases that underwent substitution urethroplasty,14 achieved satisfactory voiding,and only 1 needed repeat dialation.No serious complications were observed in any of the patients.Conclusion： Modified urethral pull-through procedure,with its advantages of safety,mini-invasiveness,simple operation and high success rate,is feasible for the treatment of posterior urethral stricture or atresia,while for that with the length 5 cm,substitution urethroplasty should be considered.

关 键 词：尿道狭窄 尿道成形术 尿道套入术 

分 类 号：R699[医药卫生—泌尿科学]