改良近端尿道断离法治疗后尿道狭窄的效果  

Effect of the improved proximal urethral transection in the treatement of posterior urethral stricture

作　　者：叶绪晓 金重睿 司捷旻 李作为 宋汶雄 撒应龙 Ye Xuxiao;Jin Chongrui;Si Jiemin;Li Zuowei;Song Wenxiong;Sa Yinglong(Department of Urology,the Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai Oriental Institure of Urinary Repair and Reconstruction,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院泌尿外科、上海东方泌尿修复重建研究所,上海200233

出　　处：《中华泌尿外科杂志》2024年第12期912-917,共6页Chinese Journal of Urology

摘　　要：目的探讨改良近端尿道断离法治疗后尿道狭窄的效果。方法回顾性分析2013年1月至2023年5月上海市第六人民医院收治的1787例骨盆骨折伴后尿道断裂或闭锁患者的临床资料。患者均为男性,年龄18个月至76岁,平均年龄(34.3±4.1)岁。车祸致骨盆挤压伤867例,高空坠落致骨盆损伤464例,车床致骨盆挤压伤456例。术前行耻骨上膀胱造瘘1536例。所有患者术前均行排泄性和逆行尿道造影,187例行尿道超声检查,1440例行尿道镜检查,38例行尿道MRI检查。狭窄或闭锁段长度(3.1±0.5)cm。后尿道狭窄(尿道连续性尚存)281例(15.7%);后尿道完全闭锁1506例(84.3%)。术前行尿道膀胱软镜和MRI检查了解精阜至狭窄或闭锁段距离,>2 cm 1434例(80.2%),≤2 cm 353例(19.8%)。术前国际勃起功能指数(IIEF-5)评分≤21分1073例,≥22分672例,42例无性活动拒绝问卷调查。手术方法:会阴区域消毒,用尿道探子自膀胱造瘘口置入,经膀胱颈口达闭锁尿道近端,用左手示指触及探子顶端于会阴处体表的冲击点并标记。以此点为中心,做倒"Y"形切口,切开皮肤、皮下组织,分离球海绵体肌,显露球部尿道。分离球部尿道并用牵引带拉出,在球部尿道上方显露瘢痕结缔组织并切开,显露会阴横韧带。在探子指引下,于尿道上方用电刀切断会阴横韧带,下方沿会阴中心腱水平方向将尿道与直肠前壁分离,两侧切断尿道周围瘢痕组织,达近端尿道探子顶端。切开探子顶端瘢痕组织后显露探子,用组织剪去除近端尿道周围瘢痕并修剪后备用。远端尿道向上方游离至足够长度后,剪除瘢痕组织,稍作修剪后备用。用4-0可吸收线分别于尿道1、2、4、5、7、8、10、11点位缝合8针,留置F16导尿管后关闭切口。术后4周拔除导尿管嘱患者自行排尿,6个月后行尿流率检查和IIEF-5评分,最大尿流率(Q_(max))>15ml/s定义为手术成功,IIEF-5评分≥22分定义为勃起功能正Objective To investigate the therapeutic efficacy of the improved proximal urethral transection method in treating posterior urethral stricture.Methods A retrospective analysis was conducted on clinical data from 1787 male patients treated from January 2013 to May 2023 for pelvic fractures associated with posterior urethral disruption or obliteration.The ages of the patients ranged from 18 months to 76 years,with an average age of(34.3±4.1)years.Etiologies included pelvic compression injuries due to traffic accidents(867 cases),falls from height(464 cases),and machine-related pelvic compression injuries(456 cases).Preoperative suprapubic cystostomy was performed in 1536 cases.All patients underwent preoperative excretory and retrograde urethrography,urethral ultrasonography in 187 cases,urethroscopy in 1440 cases,and urethral MRI in 38 cases.The average length of the stricture or obliterated segment was(3.1±0.5)cm.Posterior urethral stricture was present in 281 cases(15.7%)with maintained urethral continuity,while complete posterior urethral obliteration occurred in 1506 cases(84.3%).Preoperative urethrocystoscopy and urethral MRI were used to determine the distance from the verumontanum to the stricture or obliterated segment,>2 cm identified in 1434 cases(80.2%)and≤2 cm in 353 cases(19.8%).Before surgery,1073 cases had IIEF-5 scores≤21 points,672 cases had IEF-5 scores≥22 points,and 42 cases without sexual activity refused the questionnaire survey.Surgical method:The perineal region was disinfected,and a urethral probe was introduced through the suprapubic cystostomy site into the bladder neck,directly reaching the proximal end of the obliterated urethra.The tip of the probe was palpated with the left index finger on the body surface and marked.An inverted"Y"-shaped incision was made centered around this point,followed by dissection of the skin,subcutaneous tissue,and bulbospongiosus muscle to expose the bulbous urethra.The bulbous urethra was isolated and retracted.Scar tissue above the bulbous urethra

关 键 词：尿道闭锁 泌尿外科手术 经会阴途径 修复与重建 

分 类 号：R69[医药卫生—泌尿科学]