复杂尿道狭窄合并尿道直肠瘘的手术径路选择

目的 探讨复杂尿道狭窄合并尿道直肠瘘的手术径路选择及疗效.方法 后尿道狭窄合并尿道直肠瘘患者34例.其中医原性6例,骨盆骨折尿道损伤所致26例,坠落伤所致2例.34例均采用尿道端端吻合同时行直肠瘘修补.4例尿道狭窄段1.5～2.5 cm采用单纯性经会阴途径;30例尿道狭窄段3.0～7.0 em者采用经会阴切除耻骨下缘途径21例,经会阴与经耻骨联合途径9例. 结果 单纯经会阴途径手术4例均获成功;经会阴切除耻骨下缘途径21例中成功19例(90%),经会阴加经耻骨联合途径9例中成功7例(78%).术后仍有尿道狭窄2例,发生直肠瘘2例. 结论 复杂尿道狭窄合并尿道直肠瘘的手术径路选择应根据尿道狭窄长度、瘘道部位与大小、病因及既往手术史决定.经会阴切除耻骨下缘途径手术效果好.

Selection of operative approaches for the treatment of complicated urethral strictures

Objective This study was to discuss various operative approaches for the repair complicated posterior urethral strictures. Methods 34 patients with posterior urethral strictures and associated ure-throrectal fistulas (URFs) were reviewed. The etiology of urethral strictures and fistula was due to pelvic fracture in 26 patients, iatrogenic in 6 cases and fall injury in the remaining 2 cases. The patients were treated by using a simple perineal approach (4 patients), a transperineal inferior pubectomy approach (21 patients) and combined abdominal transpubic perineal approach (9 patients) and URF repair and anastomotic urethroplasty were performed simultaneously in all cases. Results One-stage repair was successful in four patients (100%) using a simple perineal approach, in 19 of 21 (90. 48%) using the transperineal-inferior pubectomy approach and 7 of 9 (77. 78%) using the transpubic-perineal approach. Of the 34 patients, recurrent urethral strictures developed in two cases, recurrent URFs developd in two patients. Conclusions Surgical approaches for the special complex urethral strictures should be based on the location of the URF, its etiology and length of the urethral strictures, as well as a history of previous repairs. The transperineal-inferior pubic approach may be appropriate as a first-line procedure.