提高经会阴后尿道端端吻合术成功率的探讨(附76例报告)  

Investigate transperineal terminoterminal anastomosis for posterior urethral stricture(Report of 76 cases)

作　　者：张明[1] 何恢绪[2] 王海坤[1] 肖耀军[1] 黄谷[1] 

机构地区：[1]武警广东省总队医院泌尿外科,广州510507 [2]广州军区总医院泌尿外科

出　　处：《临床泌尿外科杂志》2012年第9期694-695,697,共3页Journal of Clinical Urology

摘　　要：总结经会阴后尿道狭窄/闭锁瘢痕切除+端端吻合术的临床经验,提高一次手术成功率。方法:经会阴后尿道狭窄/闭锁瘢痕切除+端端吻合术治疗骨盆骨折所致尿道损伤继发后尿道狭窄/闭锁患者76例。对于<3cm短段狭窄/闭锁者,釆用经会阴手术入路,彻底切除瘢痕,作无张力、大口径、精确吻合;对于>3cm的狭窄/闭锁者,釆用充分游离前尿道,切开阴茎海绵体间隔等辅助方法处理,以缩小尿道断端间距;术中留置后尿道U形支架管,木后持续支撑、软扩张吻合口。结果:76例均手术成功。72例(94.7%)术后膀胱尿道造影示后尿道通畅,尿流率正常。出现短暂性尿失禁8例,无永久性尿失禁。结论:经会阴瘢痕切除+端端吻合术治疗后尿道狭窄/闭锁成功率高;较长时间留置后尿道U形支架管,持续支撑、软扩张吻合口是防止狭窄复发的好方法。Objective , To evaluate the therapeutic result of posterior urethral stricture or atresia ana improve rne success rate of an operation. Methods：Transperineal approach completely resected scar and accurately anastomosed urethra with no tension and large diameter. To long segment stenosis or atresia, urethrourethal anastomosis was performed after reduced broken part distance by the auxiliary treatment,as fully freeing the anterior urethra and cutting the cavernous body interval of penis. Indwelled U-shaped stent in the posterior urethra when finishing, which continuely supportting and flexibly dilating anastomotic. Results： All the surgery were successful. 72 patients （94.7%） were examined with cystourethrography to have normal voiding function after catheter removed, 8 eases were suffered with provisionality incontinence, no permanent incontinence. Conclusions： Transperineal approach resection scar and terminoterminal anastomosis has high achievement ratio for the management of posterior urethral stenosis or atresia. If longer indwelling flexible U-shaped stent in the posterior urethra, which may support and dilate anastomotie,it is an effective resolution to prevent the recurrence of urethral stricture.

关 键 词：尿道狭窄 尿道成形术 U形支架 

分 类 号：R694[医药卫生—泌尿科学]