三种手术入路显露男性后尿道的比较(英文)

Comparison of Three Operative Approaches Exposing Posterior Urethra

目的:评价经耻骨上、耻骨下及会阴三种手术入路暴露尿道膜部的优劣。方法:对35具成年男性尸体标本解剖,测量并比较耻骨上缘中点(A)、耻骨下缘中点(B)及会阴部两坐骨结节连线中点(C)分别到尿道球膜部连接处(D)、前列腺尖(E)及膀胱颈(F)的距离及相关角度;对另20具成年男性尸体标本分别经3种手术入路显露后尿道,标记可能损伤的组织器官并评分。结果:AD=(6.5±0.5)cm,BD=(2.2±0.5)cm,CD=(3.4±0.6)cm,其中BD<CD<AD(P<0.05,SNK法);AE=(6.6±0.5)cm,BE=(3.0±0.5)cm,CE=(4.4±0.7)cm,其中BE<CE<AE(P<0.05,SNK法);AF=(5.7±0.6)cm,BF=(4.5±0.5)cm,CF=(6.5±0.6)cm,其中BF<AF<CF(P<0.05,SNK法)。各点连线所成角度中,∠EAD(α1)=(9.3±2.0)°,∠EBD(α2)=(17.4±3.8)°,∠ECD(α3)=(9.2±1.6)°,其中α1与α2有显著性差异(P<0.05,t=11.1),α3与α2有显著性差异(P<0.05,t=12.1),α1与α3无显著性差异(P>0.05,t=0.13);∠FAE(β1)=(22.7±2.6)°,∠FBE(β2)=(32.9±6.4)°,∠FCE(β3)=(15.0±3.2)°,其中β2>β1>β3(P<0.05,SNK法)。经耻骨上入路损伤评分为13分,经耻骨下为18分,经会阴为15分。结论:暴露从优到劣依次为经耻骨下、经耻骨上、经会阴;损伤从大到小依次为经耻骨下、经会阴、经耻骨上部分。

Objective： To evaluate the advantages and disadvantages of three operative approaches exposing posterior urethra by suprapubis, inferior pubis and perineum. Methods： Thirty-five adult male corpses were dissected. The figures from the bulbomembra- nous urethra joint（D） to the suprapubis（A）, to the inferior pubis（B） and to the perineum（C） were measured, respectively. In addition, the figures from the apex of prostate（E） and the bladder neck（F） to the same three points above-mentioned were also determined. The angles of ZEAD （（~l）, ZEBD （（x2）, ZECD （（~3）, ZFAE （130, ZFBE （132） and LFCE （93） were determined. Furthermore, twenty adult male corpses were dissected by suprapubis, inferior pubis and perineum. The injured tissues and organs were marked and scored. Results： The distances and angles were described as follows： AD=（6.5± 0.5）era, BD=（2.2± 0.5） cm, CD=（ 3.43± 0.6） cm; BD〈CD〈AD（P〈0.05）; AE= （6.63± 0.5）cm, BE=（3.0＋ 0.5）cm, CE=（4.43± 0.7）cm, and BE〈CE〈AE（P〈0.05）; AF=（5.7± 0.6）era, BF=（4.53 0.5）cm, CF=（6.5± 0.6）cm; BF〈AF〈CF（P〈0.05）; ZEAD（α1）=（9.3± 2.0）° ,∠EBD（α2）=（17.4± 3.8）° , ∠ECD（α3）=（9.2± 1.6）° ; ∠FAE（β1）=（22.7± 2.6）° , ∠FBE（132）=（32.9± 6.4）° , ∠FCE（β3）=（ 15.03± 3.2）° ; β2 〉β1 〉β3 （P〈0.05）. Moreover, there was a significant difference between α1 and a2 （P〈0.05, t=-11.1）, so was between α3 and α2 （P〈0.05, t=-12.1）. The injury scores by the suprapubis are 13 points, 18 points by the inferior pubis, 15 points by perineum. Conclusions： For operative exposure, the best approach is by inferior pubis, the next is by suprapubis, the last is by perineum. The operative injuries by suprapubis is the least, followed by perineum; the most injuries, by inferior pubis.