经会阴尿道端端吻合术的经验总结

Experiences in transperineal posterior urethral end-to-end anastomosis

目的 分析总结经会阴尿道端端吻合术治疗后尿道狭窄或闭锁的手术技巧和并发症处理措施.方法 后尿道狭窄或闭锁患者138例在苏州大学附属第一医院泌尿外科接受经会阴行尿道端端吻合术,其中单纯尿道端端吻合术119例,阴茎海绵体中隔切开联合后尿道端端吻合术19例.术后观察排尿通畅情况,记录并发症发生情况.结果 随访2 - 28个月,138例患者经会阴后尿道端端吻合术均顺利完成,手术总成功率为92.75％（128/138）.初次尿道端端吻合术的成功率为95.73％（112/117）,明显高于有一次手术史的成功率为76.19％（16/21,P〈0.01）.术后并发症的发生率由高到低依次为急迫性尿失禁18.84％（26/138）、尿道口出血9.42％（13/138）、吻合口狭窄7.25％（10/138）、切口内感染4.35％ （6/138）和会阴部疼痛2.90％（4/138）.结论 经会阴尿道端端吻合术仍是治疗后尿道狭窄或闭锁的首选手术方式,通过提高手术技巧等,可以明显减少失败率.

Objective To summarize surgical technique and complications management in transperineal terminoterminal anastomosis of posterior urethral stricture or atresia.Methods A total of 138 patients with posterior urethral stricture or atresia received transperineal urethral end-to-end anastomosis,of them 119 patients underwent simple anastomosis and 19 patients underwent anastomosis by separating the corporeal bodies.Patients＇ micturition was observed and surgical complications were recorded.Results The operations were carried out in all 138 patients and the overall successful rate was 92.75% （128/138） during 2 -28 months follow-up.The successful rate of the first urethral end-to-end anastomosis was clearly higher than the rate of one operation history,95.73% （112/117） vs.76.19% （16/21,P 〈 0.01）.The incidence of postoperative complications,from high to low,was urgent urinary incontinence [18.84% （26/138）],urethral bleeding [9.42% （13/138）],anastomotic stenosis [7.25% （10/138）],incision infection [4.35% （6/138）] and perineal pain [2.90% （4/138）].Conclusions Transperineal urethral end-to-end anastomosis is still the first choice for the treatment of posterior urethral stricture or atresia,and the failure rate can be obviously reduced by improving surgical techniques.