不离断尿道海绵体的尿道端端吻合术治疗后尿道狭窄的疗效观察

The efficacy of non-transecting spongiosum end to end anastomosis of urethra for treatment of posterior urethral stricture

目的 总结不离断尿道海绵体的尿道端端吻合术治疗后尿道狭窄的初步经验,探讨该术式的疗效.方法 回顾性分析201 1年1月至2014年12月收治的26例后尿道狭窄患者的资料.年龄13 - 83岁,平均43岁.尿道狭窄的病因为外伤23例,医源性3例.后尿道狭窄段长l-3 cm,平均2 cm.2例合并前尿道狭窄.入院前所有患者均行耻骨上膀胱造瘘.全麻下行不离断尿道海绵体的尿道端端吻合术.手术取会阴倒“Y”形切口,分离出球部和阴囊部尿道,以及膜部尿道的背侧和两侧.由尿道外口和膀胱造瘘口分别向球部尿道和膜部尿道置入尿道探子作为引导,在狭窄段尿道远、近端背侧各切开正常尿道1.5 cm,将已切开尿道的周围瘢痕彻底切除.在确认吻合无张力的情况下,用3-0可吸收线在切开的远、近端尿道断端各间断缝合4针,置入14F或18F带槽硅胶尿管后打结缝线.结果 24例手术时间为45 - 65 min,平均55min（2例合并前尿道狭窄患者除外）.围手术期无感染、尿瘘等并发症,术后3-4周拔除尿管.26例随访4 -36个月,平均16个月,其中16例随访＞12个月.所有患者排尿通畅,尿流率检查示最大尿流率16.8 - 59.1 ml/s,平均25.4 ml/s.尿道造影检查示尿道管腔粗大.结论 不离断尿道海绵体的尿道端端吻合术不仅保留了尿道海绵体血供,减少了局部创伤,而且达到与传统尿道端端吻合术同样的效果,对后尿道短段狭窄或闭锁的患者足一种较好的术式.

Objective To report preliminary experiences with a novel procedure of end-to-end anastomotic repairment of posterior urethral strictures.Methods From January 2011 to December 2014,a total of 26 patients with posterior urethral strictures（2 patients with exist simultaneously anterior urethral stricture）were treated.The mean age was 43 years （rang 13-83 years）.The etiology of urethral strictures were trauma in 23 patients and iatrogenic causes in 3 patients.The mean length of urethral stricture was 2 cm （rang 1-3 cm）.Suprapubic cystostomies were performed in all 26 patients.All patients accepted the non-transecting spongiosum bulbar-membranous end to end anastomosis.During the operation,the perineal incision was made.The dorsal stricture urethra was incised,extending to the 1.5 cm normal urethra at each side.Then,the interrupted end to end suture was performed with 3-0 absorbable suture.Results The mean surgical time was 55 minutes in 24 patients（45-65 minutes）.There was no evidence of wound infection or urethrocutaneous fistula during perioperation period.The mean follow-up time for 26 patients were 16 months （4 mouths-3 years）.There was no recurrent stricture on symptomatic assessment or uroflowmetry.The patients voided well with mean peak flows rate 25.4 ml/s （16.8-59.1 ml/s）.Urethrography showed that each patient had a patent urethra with adequate lumen.Conclusions Non-transecting spongiosum end to end anastomosis of urethra technique could retain spongiosal blood support.In present preliminary study,it appears to give similar results as those of traditional anastomotic urethroplasty.