永久会阴造瘘在成人复杂前尿道狭窄治疗中的价值  

The value of definitive perineal urethrostomy for the treatment of complex adult anterior urethral strictures

作　　者：王建伟[1] 满立波[1] 黄广林[1] 何峰[1] 李贵忠[1] 徐啸[1] 李玮 朱晓斐[1] 刘振华[1] Wang Jianwei;Man Libo;Huang Guanglin;He Feng;Li Guizhong;Xu Xiao;Li Wei;Zhu Xiaofei;Liu Zhenhua(Department of Urology, Beijing Jishuitan Hospital, the Fourth Medical College of Peking University, Beijing 100096, China)

机构地区：[1]北京积水潭医院泌尿外科北京大学第四临床学院,100096

出　　处：《中华泌尿外科杂志》2019年第8期606-610,共5页Chinese Journal of Urology

摘　　要：目的总结分析永久会阴造瘘治疗成人复杂前尿道狭窄的临床效果。方法回顾性分析2012年6月至2018年2月北京积水潭医院采用永久会阴造瘘治疗的28例复杂前尿道狭窄患者的临床资料。平均年龄62.3岁(34.0~77.0岁),其中22例>60岁。前尿道狭窄原因:苔藓样硬化13例,前列腺电切术后医源性狭窄10例,尿道下裂术后3例,感染性及特发性前尿道狭窄各1例。尿道狭窄平均长度9.6 cm(4.5~16.0 cm),其中2例<5 cm,10例5~10 cm ,16例>10 cm。既往行尿道扩张治疗21例,直视下内切开4例,前尿道成形手术17例。患者合并高血压病17例,缺血性心脏病(包括支架植入术后)11例,糖尿病9例,慢性阻塞性肺病9例。28例均采用倒U形会阴皮瓣技术行永久会阴造瘘。患者取截石位,会阴区倒U形切口。切开皮肤及皮下组织,沿球海绵体肌表面游离会阴皮瓣。打开球海绵体肌显露尿道球部,将倒U形皮瓣顶部中点与球部尿道切口近端6点处全层吻合,然后依次分别向左、右侧将倒U形皮瓣顶部与球部尿道切口下半部分吻合。最后缝合尿道海绵体切口远端与周围皮肤,成形球部尿道会阴造瘘口。手术成功定义为术后保持排尿通畅无需其他手术干预。记录患者治疗效果并随访满意度。结果本研究28例中3例术后出现泌尿系感染,1例术后出血,1例伤口裂开。平均随访27.2个月(6.0~64.0个月),2例分别在术后2个月和4个月出现尿线变细,复查发现瘘口处狭窄,均需定期行尿道扩张。其中1例拟行会阴造瘘修整手术;另1例因高龄拒绝再次手术,门诊定期扩张会阴瘘口。术后平均最大尿流率26.5 ml/s(17.0~40.0 ml/s),手术成功率为92.9%(26/28)。随访结果显示28例中15例对手术非常满意,9例满意,4例不满意,满意率为85.7%(24/28)。结论采用永久会阴造瘘治疗成人复杂前尿道狭窄的手术成功率高,患者满意度高,疗效确切,尤其适合高龄、一般状况较差的患者Objective To analyze the clinical outcome of definitive perineal urethrostomy for the treatment of complex adult anterior urethral strictures. Methods From June 2012 to February 2018, 28 patients who underwent the definitive perineal urethrostomy for a complex anterior urethral stricture were retrospectively reviewed. The mean age of the patients was 62.3 (range 34 to 77) years and stricture etiology was lichen sclerosus in 46.4%(13/28) of the cases, iatrogenic stricture after transurethral resection of the prostate in 35.7%(10/28), failed hypospadias repair in 10.7%(3/28), infection 3.6%(1/28) and idiopathic etiology 3.6%(1/28). The mean stricture length was 9.6 (range 4.5 to 16.0) cm and the stricture length <5 cm in 7.1%(2/28) of the cases, 5-10 cm in 35.7%(10/28) and >10 cm in 57.1%(16/28). Of 28 patients 21 (75%) underwent prior urethral dilation, 4 (14.3%) underwent direct vision internal urethrotomy (DVIU) and 17 (60.7%) underwent urethroplasty. Among the medical history of interest, hypertension was observed in 17 patients (60.7%), chronic ischemic heart disease in 11 patients (39.3%), diabetes mellitus in 9 patients (32.1%) and chronic obstructive pulmonary disease (COPD) in 9 patients (32.1%). All patients completed the perineal urethrostomy with inverted U-shaped perineal skin flap. The patient was placed in a normal lithotomy position and an inverted U-shaped perineal incision was made. We can get an inverted U-shaped perineal skin flap after dissecting along the bulbospongiosus muscle. The bulbar urethra was opened along the ventral surface and the margins of the spongiosum tissue were closed with perineal skin flap. We analyzed the clinical characteristics of the patients, the outcome of the technique and investigated the satisfaction rates of the patients by outpatient follow-up or telephone interview. Surgical success was defined as functional voiding without the need for further procedures. Results The perioperative complications included 3 cases of urinary tract infection, 1 case of bleeding and

关 键 词：尿道狭窄 前尿道 会阴造瘘 尿液分流 

分 类 号：R699.6[医药卫生—泌尿科学]