经会阴途径后尿道吻合术442例经验总结

Posterior Urethra-stomy by Perineum Pathway:442 Cases Report

【目的】总结经会阴途径后尿道狭窄瘢痕切除端端吻合的经验，提高一次手术成功率。【方法】回顾分析近30年来442例经会阴途径切除后尿道狭窄瘢痕、端端吻合的患者资料。【结果】1976～1985年129例，一次性手术成功101例（78．2％）；1986～1995年146例，一次性手术成功131例（89．7％）；1996～2005年167例，一次性手术成功162例（97．0％），其中复杂性尿道狭窄患者46例，一次性手术成功43例（93．5％），159例尿流率正常（95．2％）。术后发生阳瘘2例，有4例术前有阳瘘者术后症状好转。术后出现短暂尿失禁18例，无永久性尿失禁患者。【结论】经会阴途径瘢痕切除端端吻合治疗后尿道狭窄的成功率高，积极的围手术期处理是提高手术成功率，降低并发症的关键。

[Objective] To summarize the experience of the removal of cicatricle and end-end anastomosis by perineum pathway for the treatment of posterior urethral stricture. [Methods] Clinical data of 442 patients who were performed the removal of cicatricle and end-end anastomosis by perineum pathway in recent 30 years were retrospectively analyzed.[Results] One hundred and one（78.2%） in 129 patients were operated successfully for once in 1976-1985, 131（89.7%） in 146 patients in 1986-1995,and 162（97.0%） in 167 patients in 1996-2005. Forty six in all patients were complexity posterior urethral stricture, and 43 （93.5%） patients were operated successfully for once. Urine flow rate of 159 （95.2%） patients became normal. Asynodia occurred in 2 patients after operation, and the symptom in 4 patients with asynodia before operation improved after operation. Transient urinary incontinence occurred in 18 patients. [Conclusion] The removal of cicatricle and end-end anastomosis by perineum pathway has high achievement ratio for the treatment of posterior urethral stricture. Active management in peri-operation is a key to improve achievement ratio and decrease complications.