Tuohy针后尿道吻合术治疗瘢痕性后尿道狭窄

Tuohy′s needle in surgical treatment of stricture of posterior urethra

目的 探索提高瘢痕性后尿道狭窄治疗效果的方法。 方法 经会阴径路切除后尿道瘢痕组织 ,采用硬膜外穿刺的Tuohy针行尿道横褥式外翻吻合术治疗瘢痕性后尿道狭窄 49例。患者年龄 13～ 6 8岁 ,平均 42岁。全部病例均经膀胱尿道造影确诊 ,后尿道狭窄长度多在 3cm左右 ,最长者达 5cm。 结果 一次性手术治愈率 91 8% ,45例患者术后排尿通畅 ,不需尿道扩张 ,最大尿流率>15ml/s。术后随访 6个月～ 14年 ,1例术后 1年再发后尿道狭窄 ,经再次手术后治愈。 3例经定期尿道扩张后排尿良好。 1例病史 13年的患者术后 3个月恢复生育能力。 3例术后出现不同程度阳萎 ,1例半年后逐渐恢复。 结论 采用Tuohy针后尿道吻合术治疗瘢痕性后尿道狭窄有较高的成功率和满意的治疗效果 ,是较为理想的手术方式之一。

Objective To evaluate the therapeutic results of transperineal urethroplasty for posterior urethral stricture. [WT5”HZ]Methods[WT5”BZ] Tuohy′s needle was used in the surgical treatment of 49 patients with posterior urethral stricture. The age of the patients ranged from 13 to 68 years (mean of 42). The patients were confirmed by vesicourethrography with the longest stricture of 5 cm and the usual stricture of 3 cm. Complete excision of scar tissue was accomplished, and an end to end anastomosis of the urethra with everting suture was performed with Tuohy′s needle. [WT5”HZ]Results[WT5”BZ] The 49 patients were followed up for 6 months to 14 years after operation. Satisfactory result was observed in 45 patients (91 8%), with good voiding and no need of urethral dilatation with the MFR of more than 15 ml/s. One patient had relapsed one year later was successfully cured with the same procedure. Three patient had sound voiding by periodical urothral dilatation, including one patient with the disease for 13 years regained the reproductive ability 3 months after operation. Three patients had different level impotence after operation, and one of them recovered 6 months later. [WT5”HZ]Conclusions[WT5”BZ] This procedure has a high success rate and sound therapeutic effects.