中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2011年
10期
933-936
,共4页
沈文浩%张恒%李新%鄢俊安%李为兵%卢根生%陈志文%周占松%宋波%金锡御%熊恩庆
瀋文浩%張恆%李新%鄢俊安%李為兵%盧根生%陳誌文%週佔鬆%宋波%金錫禦%熊恩慶
침문호%장항%리신%언준안%리위병%로근생%진지문%주점송%송파%금석어%웅은경
男性%创伤%后尿道狭窄%手术
男性%創傷%後尿道狹窄%手術
남성%창상%후뇨도협착%수술
Male%Trauma%Posterior urethral stricture%Surgery
目的 探讨男性创伤性复杂性后尿道狭窄的手术治疗效果.方法 回顾性分析479例诊断为创伤性复杂性后尿道狭窄患者的临床资料.其中422例Ⅰ期行尿道狭窄段切除+端端吻合术,57例行带血管蒂阴囊皮瓣后尿道成形术.结果 手术时间平均115 min(90～140 min),术中平均出血量225 ml(100～300 ml).无一例需术中输血.术后平均随访15个月(12 ～24个月),422例行尿道吻合术的患者中,386例排尿通畅,36例排尿不畅的患者中,再次行排泄性尿道造影提示21例是因为吻合口瓣膜形成,15例因局部存在狭窄环,行尿道瓣膜切除或狭窄环内切开术,术后恢复良好.57例行后尿道成形术患者中,45例排尿通畅；9例患者出现前尿道与皮管吻合口狭窄,其中4例行尿道扩张后好转,5例行尿道狭窄内切开术后好转；3例出现皮管与后尿道或膀胱颈吻合口狭窄,其中1例经尿道扩张后好转,2例行尿道狭窄内切开术后好转.结论 Ⅰ期尿道狭窄段切除+端端吻合术是治疗创伤性复杂性后尿道狭窄的主要方法,病情不允许时可行后尿道成形术.
目的 探討男性創傷性複雜性後尿道狹窄的手術治療效果.方法 迴顧性分析479例診斷為創傷性複雜性後尿道狹窄患者的臨床資料.其中422例Ⅰ期行尿道狹窄段切除+耑耑吻閤術,57例行帶血管蒂陰囊皮瓣後尿道成形術.結果 手術時間平均115 min(90～140 min),術中平均齣血量225 ml(100～300 ml).無一例需術中輸血.術後平均隨訪15箇月(12 ～24箇月),422例行尿道吻閤術的患者中,386例排尿通暢,36例排尿不暢的患者中,再次行排洩性尿道造影提示21例是因為吻閤口瓣膜形成,15例因跼部存在狹窄環,行尿道瓣膜切除或狹窄環內切開術,術後恢複良好.57例行後尿道成形術患者中,45例排尿通暢；9例患者齣現前尿道與皮管吻閤口狹窄,其中4例行尿道擴張後好轉,5例行尿道狹窄內切開術後好轉；3例齣現皮管與後尿道或膀胱頸吻閤口狹窄,其中1例經尿道擴張後好轉,2例行尿道狹窄內切開術後好轉.結論 Ⅰ期尿道狹窄段切除+耑耑吻閤術是治療創傷性複雜性後尿道狹窄的主要方法,病情不允許時可行後尿道成形術.
목적 탐토남성창상성복잡성후뇨도협착적수술치료효과.방법 회고성분석479례진단위창상성복잡성후뇨도협착환자적림상자료.기중422례Ⅰ기행뇨도협착단절제+단단문합술,57례행대혈관체음낭피판후뇨도성형술.결과 수술시간평균115 min(90～140 min),술중평균출혈량225 ml(100～300 ml).무일례수술중수혈.술후평균수방15개월(12 ～24개월),422례행뇨도문합술적환자중,386례배뇨통창,36례배뇨불창적환자중,재차행배설성뇨도조영제시21례시인위문합구판막형성,15례인국부존재협착배,행뇨도판막절제혹협착배내절개술,술후회복량호.57례행후뇨도성형술환자중,45례배뇨통창；9례환자출현전뇨도여피관문합구협착,기중4례행뇨도확장후호전,5례행뇨도협착내절개술후호전；3례출현피관여후뇨도혹방광경문합구협착,기중1례경뇨도확장후호전,2례행뇨도협착내절개술후호전.결론 Ⅰ기뇨도협착단절제+단단문합술시치료창상성복잡성후뇨도협착적주요방법,병정불윤허시가행후뇨도성형술.
Objective To investigate the therapeutic effect of post-traumatic complex posterior urethral stricture in the male patients.Methods Clinical data of 479 male patients with post-traumatic complex posterior urethral stricture were reviewed.One-stage resection of the stenosis and end-to-end anastomosis was performed in 422 patients and scrotal flap with blood pedicle posterior urethroplasty in 57.Results The mean operation time was 115 minutes(range,90-140 minutes).The mean blood loss was 225 ml(range,100-300 ml).No intraoperative blood transfusion was needed.The mean follow-up time was 15 months(range,12-24 months).Among the 422 patients performed end-to-end anastomosis,386 patients had good voiding and 36 had dysuria because of the formation of anastomotic stoma valve(21 patients)or stricture ring(15 patients).The problem was resolved by transurethral valve/stricture ring resection.Among 57 patients undergone posterior urethroplasty,45 patients had good voiding nine patients were found with anterior urethra-skin tube anastomotic stoma stricture,of which four patients were treated by urethral dilatation and five by endourethrotomy; three patients were found with posterior urethra-skin tube anastomotic stoma stricture,of which one patient was treated by urethral dilation and two by endourethrotomy.Conclusions One-stage resection of the stenosis and end-to-end anastomosis is the main treatment for post-traumatic complex posterior urethral stricture.If the condition of the patients does not allow the end-to-end anastomosis,posterior urethroplasty can be an alternative.
