自制“灯笼式”后尿道吻合器在后尿道狭窄术中的应用

Application of a self-made "lantern" posterior urethral stapler in surgery of posterior urethral stricture

目的探索提高后尿道狭窄治疗效果的方法。方法选取2016年10月至2018年12月中国人民解放军第九二四医院泌尿男科诊治的35例后尿道狭窄患者作为研究对象。年龄范围12岁~72岁,平均45岁。全部病例均经膀胱尿道造影确诊,后尿道狭窄长度1 cm^4.5cm,平均2.5cm。3例合并前尿道狭窄。经会阴径路行倒'Y'切口,分离球部及阴囊部尿道,在狭窄处切断尿道,充分切除后尿道瘢痕组织,采用自制'灯笼式'后尿道吻合器在显示器直视下用3-0可吸收线间断行后尿道吻合6针~8针。27例行狭窄后尿道切除后端端吻合,8例采用阴囊纵隔带蒂皮瓣卷管成尿道后与后尿道行端端吻合。结果手术时间50 min^120min,平均75min,术后2周~3周拔出导尿管,随访2个月~28个月,平均14个月。35例患者术后排尿通畅,不需尿道扩张,最大尿流率>15ml/S。一次性手术治愈率94%。2例术后再狭窄,1例行尿道扩张治愈,1例再次行狭窄部切除吻合治愈。结论采用自制'灯笼式'后尿道狭窄吻合器行后尿道吻合术治疗瘢痕性后尿道狭窄,吻合方便,手术时间短,成功率高,是一种较好的手术方式。

Objective To explore the method of improving the surgical result of operation managment in posterior urethral stricture.Methods 35 patients withposterior urethral stricturestreated in our hospital from October 2016 to December 2018 were selected,the mean age of 45 years old(ranged from12 to 72 years old).All the cases were evaluated by cystourethrography preoperatively.The mean length ofposterior urethral stricture was2.5 cm(ranged from 1 to 4.5 cm).3 patients were complicated with anterior urethralstricture.All the cases had an inverted'Y'shaped skin perineal incision,cutting off the stenosis of the urethra and resecting the scar tissue completely after separating the bulbour and scrotumurethra.A self-made'lantern'posterior urethral stapler was used to perform intermittent posterior urethral anastomosis with 3-0 absorbable lines under direct vision of the monitor,and 6-8 stitches were performed.27 patients underwent resection of the posterior urethrathen had anend-to-end anastomosis and 8 patients underwent end-to-end anastomosis of the posterior urethra after resection of the posterior urethra instead of the pedicle scrotal flap.Results The meansurgical time was 75 minutes(ranged from 50 to 120 minutes)and the urethral catheter was removed 2 to 3 weeks postoperative.The mean follow-up time was 14 months(ranged from 2 to 28 months).There was no recurrent stricture on symptomatic assessment or uroflowmetry.The maximum urine flow rate was>15 ml/S,and the cure rate of one-time surgery was 94%.Urethral dilatation was performed in a patient and anastomosis was performed in a patient.Conclusion It is apreferablesurgical method for the treatment of cicatricial posterior urethral stricture by a self-made'lantern'posterior urethral stricture stapler,with convenient anastomosis,short operation time and high success rate.