以尿道起始部为切入点保留尿道前列腺切除术

Modified madigan prostatectomy:a direct approach to exposure the prostatic urethra

目的 改良经典的保留尿道前列腺摘除 (Madigan)术的手术方法。 方法 利用尿道起始部无增生腺体遮盖 ,对 12例前列腺增生症患者采用改良的Madigan前列腺摘除术 ,术中将前列腺包膜横切口移至距膀胱颈约 1.0cm处 ,显露无增生腺体覆盖的尿道起始部 ,直视下分离出尿道 ,切除增生的腺体。结果 12例中 7例尿道保留完整 ,5例尿道破裂。术中出血约 12 0～ 45 0ml ,平均约 2 40ml,均未输血。手术时间 70～ 15 0分钟 ,平均 95分钟。 11例随访 1～ 6个月 ,手术效果良好。结论 利用尿道超始部为切入点的改良的术式可简化经典的Madigan前列腺切除术的主要技术难点 ,并扩大了手术适应范围。

Objectives To present and evaluate a modified method of Madigan prostatectomy.Methods Because the starting part of urethra near the bladder neck isn't surrounded by hyperplastic and fibromuscular tissue,it could be directly exposed after incising the prostatic capsule in the distance of 1 cm to the bladder neck.So the exposure and dissection of the posterior urethra is much easier.12 cases of BPH underwent the modified Madigan prostatectomy with the use of the new approach.Results The posterior urethra was kept intact during surgery in 7 whereas there was a miner injury in 5.All the 12 cases have had a good urinary stream without complication.Conclusions The above mentioned bare area of posterior urethra serves as a good anatomical mark during surgery,which make the exposure and dissection of urethra much easier with less chance of injury to the urethra.