改良尿道拖入术治疗外伤性后尿道狭窄36例疗效分析

Modified Urethral Pull-through Procedure for Post-trauma Posterior Urethral Stricture

目的:探讨中号硅胶引流管作为牵引固定装置的改良尿道拖入术,治疗外伤性后尿道狭窄或闭锁的效果。方法:2001年1月～2005年6月我科采用此方法治疗复杂外伤性后尿道狭窄或闭锁患者36例。其中25例为骨盆骨折外伤后1期尿道会师术术后尿道闭锁,余11例为骨盆骨折外伤后仅行膀胱造瘘术。尿道狭窄长度1.0～4.5cm,平均2.2cm。患者年龄17～59岁,平均44.5岁。术前并发ED9例。结果:术后随访1年,25例排尿通畅,无需尿道扩张;6例术后需行尿道扩张3～6次;3例术后需定期尿道扩张1年以上(1～3个月扩1次);2例失败。手术中无1例需要输血,术后ED患者无增加,无术后尿失禁发生。结论:改良尿道拖入术操作简单,手术效果好,损伤小,无ED、尿失禁发生。

Objective ： To evaluate the effect of the modified urethral pull-through procedure in the surgical treatment of posterior urethral stricture or ohliteration caused by trauma. Methods ： From January 2001 to June 2005, modified urethral pull-through procedures were performed in 36 patients with post-trauma posterior urethral stricture or obliteration, 25 of them with peat-operation urethral stricture or obliteration after urethral realignment by traction and the other 11 treated by cystostomy at the time of initial injury. The length of the urethral stricture segment was 1.0-4.5 cm, mean 2.2 cm. The patients were aged from 17 to 59 years （ mean 44.5 years ）. Results ： All the patients were followed up for at least 1 year. Success was achieved in 34 patients, among whom 25 had good voiding and no need of dilation, 6 were cured after 3 - 6 pest-operative dilations, 3 required dilation every 2 or 3 months for over a year and 2 failed. No blood transfusion was needed during the operation, and no erectile dysfunction or incontinence occurred after it. Conclusion ： The modified urethral pull-through procedure is effective and simple in the surgical treatment of pest-trauma posterior urethral stricture or obliteration, with few complications and no consequent erectile dysfunction or incontinence.