经耻骨及会阴联合修复男童复杂性外伤性后尿道闭锁

Combined Transpubic and perineal approach to repair complicated traumatic posterior urethral obliteration in boys

１９８４～１９９４年共治疗男童外伤性后尿道狭窄或（及）闭锁８１例，其中３２例为复杂性后尿道闭锁，即闭锁段在尿生殖隔以上，长度超出２ｃｍ者。年龄３～１２岁，平均８岁。１９９０年前切除宽２ｃｍ的全耻骨联合共１１例，１９９０以后改为切除头侧３／４，共２１例。３２例３５次切开耻骨联合。两组如加会阴切口，游离远端尿道时均切开阴茎海绵体中隔２ｃｍ，并切除耻骨联合下缘以缩短尿道径路，则便于尿道端端吻合或会阴部尿道造瘘，二期吻合。术后３０例排尿通畅，８例有不全尿失禁，随年龄增长，逐渐好转，２例失败等待再次手术。

In the recent l0 years(1984～1994),repair of traumatic posterior urethral stricture or/and obliteration was carried out in 8l boys including 32 complicated ones,the length of the obliterated segment being longer than 2cm.The age of patients ranged from 3 to 12 with a mean of 8.Total pubectomy wes undertaken before l990 in 11 and partial pubectomy since l990 in 21.35 sessions of pubectomy were carried out in 32 patients.Perineal incision was also made to facilitate mobilization of the distal end of the urethra.About 2 cm of the penile spongiosum septum was separated and the lower edge of the symphysis pubis excised so as to shorten the course of the urethra.30 patients(94%)could pass urine freely including 8 with incomplete urinary incontinence.The operative repair failed in 2.