耻骨下缘部分切除辅助后尿道吻合术在男性骨盆骨折后尿道离断修复中的应用  

Outcomes of partial pubectomy assisted anastomotic urethroplasty for male patients with pelvic fracture urethral distraction defect

作　　者：王建伟[1] 徐啸[1] 鲍正清 刘振华[1] 何峰[1] 黄广林[1] 满立波[1] WANG Jian-wei;XU Xiao;BAO Zheng-qing;LIU Zhen-hua;HE Feng;HUANG Guang-lin;MAN Li-bo(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,北京大学第四临床医学院泌尿外科,北京100096

出　　处：《北京大学学报（医学版）》2021年第4期798-802,共5页Journal of Peking University:Health Sciences

基　　金：北京市属医院科研培育项目(PX2021017)。

摘　　要：目的:总结耻骨下缘部分切除技术辅助后尿道吻合术治疗男性骨盆骨折后尿道离断(pelvic fracture urethral distraction defect,PFUDD)的临床效果并分析其技术要点。方法:回顾性分析采用耻骨下缘部分切除技术辅助后尿道吻合术治疗的男性PFUDD患者63例,患者均以以下步骤完成后尿道吻合:(1)充分游离尿道海绵体球部,在尿道闭锁处切断尿道并切除瘢痕;(2)向远端适当游离尿道海绵体,劈开阴茎海绵体纵隔;(3)切除耻骨联合下缘,完成无张力吻合。结果:63例患者的平均年龄(39.2±15.6)岁(15~72岁),平均尿道狭窄长度(3.85±0.91)cm(1.5~5.5 cm),均采用耻骨下缘切除技术辅助完成后尿道吻合,手术时间平均为(160.2±28.1)min(110~210 min),术中估计失血量为(261.1±130.3)mL(100~800 mL),术后或术中输血者3例(4.8%)。术后并发症包括出血和泌尿系感染,均对症处理后治愈。患者的中位随访时间为23个月(12~37个月),术后平均最大尿流率为(23.7±7.4)mL/s(15.0~48.2 mL/s)。耻骨下缘切除技术辅助后尿道吻合治疗男性PFUDD的手术成功率为95.2%(60/63例)。结论:耻骨下缘部分切除能够有效缩短远近端尿道间距离,辅助部分复杂PFUDD患者完成无张力吻合,技术要点包括阴茎海绵体纵隔切开充分暴露耻骨联合、游离结扎阴茎背静脉、充分切除耻骨骨质下方与尿道之间瘢痕组织暴露健康尿道近端。Objective:To summarize the clinical outcomes of partial pubectomy assisted anastomotic urethroplasty for male patients with pelvic fracture urethral distraction defect(PFUDD)and discuss the skills of partial pubectomy.Methods:The clinical data of 63 male patients with PFUDD were retrospective reviewed.The procedure of the anastomotic urethroplasty was as follows:(1)circumferentially mobilizing the bulbar urethra;(2)separating the corporal bodies;(3)performing the urethral anastomosis after partial pubectomy and exposure of the healthy two ends of the urethra.Results:The mean age of the patients was(39.2±15.6)years(range:15-72 years).The median time between incidents and operation was 15 months(range:3-240 months)and the mean length of stricture was(3.85±0.91)cm(range:1.5-5.5 cm).All the patients had undergone suprapubic cystostomy in acute setting.Thirteen patients(20.6%)were re-do cases and the patients who had undergone dilation,direct vision internal urethrotomy(DVIU),and open primary realignment were 22(34.9%),8(12.7%),and 8(12.7%),respectively.Assisted with partial pubectomy,the anastomotic urethroplasty had been successfully performed in all the patients.The mean time of operation was(160.2±28.1)min(110-210 min),and the mean evaluated blood loss was(261.1±130.3)mL(100-800 mL).There were 3 cases(4.8%)with perioperative blood transfusions.The postoperative complications were bleeding and urinary tract infection,which were controlled conservatively.The mean maximum urine flow rate was(23.7±7.4)mL/s(15.0-48.2 mL/s)after removing the catheters 4 weeks after urethroplasty.The median follow-up was 23 months(12-37 months).The urethroscopy showed 2 cases of stricture recurrences and 1 case of iatrogenic penile urethral stricture due the symptoms of urinary tract infection and decreased urine flow and all of them were successfully managed with dilation.Conclusion:Partial pubectomy can effectively reduce the gap between the ends of the urethra and promote tension-free anastomosis during the anastomotic urethropls

关 键 词：耻骨部分切除 后尿道吻合成形术 骨盆骨折后尿道离断 尿道狭窄 

分 类 号：R699.6[医药卫生—泌尿科学]