直接显露尿道入路的改良Madigan前列腺切除术(附12例报告)  

Modified Madigan prostatectomy: A direct approach to exposure the prostatic urethra(report of 12 cases)

作　　者：蔡伟[1] 叶林阳[1] 肖序仁[1] 洪宝发[1] 王晓雄[1] 

机构地区：[1]解放军总医院泌尿外科,北京100853

出　　处：《中华泌尿外科杂志》2000年第9期537-539,共3页Chinese Journal of Urology

摘　　要：目的　改进Madigan前列腺切除术的手术方法。　 方法　分析前列腺增生 (BPH)组织标本 ,认识尿道前列腺部有部分无增生组织覆盖的区域。对 12例前列腺增生患者采用改良Madigan前列腺切除术。术中将前列腺包膜横切口移至近膀胱颈部 ,显露无增生组织覆盖的尿道区域 ,直视下分离出尿道 ,完整切除增生腺体。　结果　 12例术中均能显露无增生组织覆盖的区域 ,清晰地分开尿道与增生腺体。 10例尿道保留完整 ,2例尿道破裂。术中出血 80～ 30 0ml,平均 16 0ml,均未输血。手术时间 80～ 130min ,平均 10 0min。 10例随访 1～ 10个月 ,IPSS由术前平均 2 5 .2降至术后平均6 .2 ,Qmax由术前平均 8.5ml/s降至术后平均 19.2ml/s。　结论　利用前列腺尿道部无增生组织覆盖的区域 ,可以简化Madigan术式的主要技术难点。Objective To present and evaluate a new approach for Madigan prostatectomy. Me- thods On the study of resected hyperplastic prostates,a region without surrounding hyperplastic and fibromuscular tissue was found at the anterior prostatic urethra near the bladder neck.This bare part of the urethra could directly exposed after incising the prostatic capsule.Making the exposure and dissection of the posterior urethra much easier.12 cases of BPH underwent the modified Madigan prostatectomy with the use of this new approach. Results The average preoperative IPSS was 25.2,the Qmax 8.5ml/s.The posterior urethra was kept intact during surgery in 10 whereas there was a minor injury in 2.All the 12 have had a good urinary stream without complication.The average postoperarive IPSS has been 6.2,the average Qmax 19.2ml/s. Conclusions The above mentioned bare area of posterior urethra serves as a good anatomical mark during surgery making the exposure and dissection of the urethra much easier with less chance of injury to the urethra.

关 键 词：前列腺增生 外科手术 MADIGAN手术 

分 类 号：R699.8[医药卫生—泌尿科学]