北京大学学报(医学版) ›› 2018, Vol. 50 ›› Issue (4): 617-620.doi: 10.3969/j.issn.1671-167X.2018.04.007

• 论著 • 上一篇    下一篇

经会阴三步法手术策略治疗单纯性男性骨盆骨折后尿道离断

王建伟,满立波△,黄广林,王海,徐啸,朱晓斐,李玮,刘振华   

  1. (北京积水潭医院泌尿外科,北京大学第四临床医院, 北京100096)
  • 出版日期:2018-08-18 发布日期:2018-08-18
  • 通讯作者: 满立波 E-mail: mmanlibo@sohu.com

“3-step” strategy of transperineal anastomotic urethroplasty for the simple pelvic fracture urethral distraction defect in male patients

WANG Jian-wei, MAN Li-bo△, HUANG Guang-lin, WANG Hai, Xu Xiao, ZHU Xiao-fei, LI Wei, LIU Zhen-hua   

  1. (Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China)
  • Online:2018-08-18 Published:2018-08-18
  • Contact: MAN Li-bo E-mail: mmanlibo@sohu.com

摘要: 目的:总结经会阴三步法手术策略治疗男性单纯性骨盆骨折后尿道离断(pelvic fracture urethral distraction defect, PFUDD)的临床效果及体会。方法:回顾性分析2014年1月至2015年10月收治的男性单纯性PFUDD患者162例,均无会阴瘘和直肠瘘等并发症,为单纯性PFUDD。既往行经会阴尿道吻合术30例(18.5%),尿道会师术17例(10.5%), 尿道内切开17例(10.5%), 余均为伤后急诊行膀胱造瘘,未行其他处理措施。按照经会阴三步法策略行后尿道吻合成形:第一步,游离尿道海绵体球部并切除瘢痕,行远近端尿道吻合成形;如果远近端尿道无法吻合或吻合口张力较大,则依次行以下第二步和第三步;第二步,向远端适当游离尿道海绵体,劈开尿道海绵体纵膈以缩短吻合口远近端距离;第三步,耻骨部分或整块切除,进一步缩短吻合口距离并充分暴露近端尿道。结果:本组患者年龄平均36.3(16~74)岁,创伤性尿道损伤病史平均13.5(3~124)个月,患者尿道狭窄长度平均2.7(0.5~6.5) cm,手术时间平均92(45~240) min,术中平均估计失血量120(60~800) mL,术后或术中输血3例(1.9%)。162例患者采用经会阴三步法手术策略均达到无张力吻合(162/162,100%),其中第一步完成吻合50例(30.9%);第一步结合第二步完成74例(45.7%);使用三个步骤完成38例(23.5%), 其中耻骨整块切除4例(2.5%)。患者平均随访19.5(11~45)个月,18例患者术后狭窄复发,手术成功率为88.9%(144/162)。结论:采用经会阴三步法手术策略治疗男性单纯创伤性后尿道狭窄效果明确,均能够达到无张力吻合效果,手术成功率为88.9%。

关键词:  , 后尿道吻合成形术, 骨盆骨折后尿道离断, 后尿道狭窄

Abstract: Objective: To evaluate the clinical effect of “3-step” strategy of transperineal anastomotic urethroplasty for the simple pelvic fracture urethral distraction defect in male patients. Methods: We retrospectively reviewed the clinical data of 162 male patients with simple traumatic posterior urethral stricture or stenosis admitted from January 2014 to October 2015. All had no complex complications, such as urethroperineal fistulas or urethrorectal fistulas. Before referral to Department of Urology, Beijing Jishuitan Hospital, 64 patients had undergone previous treatments: urethroplasty in 30 patients (18.5%), early urethral realignment in 17 patients  (10.5%) and 17 patients (10.5%) who had undergone internal urethrotomy. The remaining 98 patients received the suprapubic cystostomy in the acute setting. All of them had received transperineal anastomotic urethroplasty with “3-step” strategy. Step 1, the bulbar urethra was circumferentially mobilized and tension-free anastomosis could be performed after the scar was completely incised and removed. Step 2, If after step 1 a tension-free anastomosis could not be achieved, were routed the distal urethra between the separated corporal bodies. Step 3, If the anastomosis still seemed to be under tension, we could perform pubectomy, partial or total removal, to get a better exposure of the apex of the prostate-membranous urethra. Results: The mean age of the patients included in this study was 36.3 years (rangingfrom 16-74 years). The mean time between incidents and operation was 13.5 months (ranging from 3-124 months) and the mean length of stricture was 2.7 cm (ranging from 0.5-6.5 cm).The mean time of operation was 92(45-240) min and the mean evaluated blood lose was 120(60-800) mL. Three patients (1.9%) received blood transfusing during or after the opera-tions. The numbers of the patients who completed step 1, step 2 and step 3 were 50(30.9%), 74(45.7%) and 38(23.5%), respectively. There were 4 (2.5%) patients who needed the combined transpubic and transperineal approach for tension-free anastomosis after removing an entire wedge of anterior pubis. The mean follow-up was 19.5 months and 18 patients’ strictures recurred with manifestation of decreased stream of dysuria. The overall success rate was 88.9%(144/162). Conclusion: Based on the “3-step” strategy of transperineal anastomotic urethroplasty, patients with simple PFUDD can achieve a tension-free anastomosis. The present clinical data showed a successful rate of 88.9% (144/162).

Key words: Posterior urethral anastomotic urethroplasty, Pelvic fracture urethral distraction defect, Posterior urethral stricture

中图分类号: 

  • R691.6
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