治疗复杂性后尿道狭窄3种手术入路的比较解剖学研究

目的 评价经耻骨上、耻骨下、会阴3种手术入路治疗复杂性后尿道狭窄的优劣。方法 解剖35具成年男性尸体标本,测量并比较耻骨上缘中点(A)、耻骨下缘中点(B)及会阴部两坐骨结节连线中点(C)分别到尿道球膜部连接处(D)、前列腺尖(E)及膀胱颈(F)的距离及相关角度;对另20具成年男性尸体标本分别经3种手术入路显露后尿道,标记可能损伤的组织器官并评分。结果 各点之间的距离AD=(6.5±0.5)cm,BD=(2.2±0.5)cm,CD=(3.4±0.6)cm,BDP<0.05,SNK法);AE=(6.6±0.5)cm,BE=(3.0±0.5)cm,CE=(4.4±0.7)cm,BEP<0.05,SNK法);AF=(5.7±0.6)cm,BF=(4.5±0.5)cm,CF=(6.5±0.6)cm,BFP<0.05,SNK法)。各点连线所成角度中,∠EAD (α₁)=(9.3±2.0)°,∠EBD (α₂)=(17.4±3.8)°,∠ECD (α₃)=(9.2±1.6)°,α₁与α₂有显著性差异(P<0.05,t=11.1),α₃与α₂有显著性差异(P<0.05,t=12.1),α₁与α₃无显著性差异(P>0.05,t=0.13);∠FAE (β₁) =(22.7±2.6)°,∠FBE (β₂ )=(32.9±6.4)°,∠FCE (β₃)= (15.0±3.2)°,其中β₂>β₁>β₃(P<0.05,SNK法)。经耻骨上入路损伤评分为13分,经耻骨下为20分,经会阴为15分。结论 暴露从优到劣依次为经耻骨下、经耻骨上、经会阴;损伤从大到小依次为经耻骨下、经会阴、经耻骨上部分。对于复杂

Comparative anatomical study of three surgical approaches for treating complex posterior urethral stricture

Objective To evaluate the advantages and disadvantages of 3 surgical approaches via superior intermedial margin of the pubis, inferior medial margin of the pubis, and the perineum, respectively, in the treatment of posterior urethral stricture.Methods Thirty-five adult male corpses were disse cted in which the distances from the bulbo-membranous urethra conjuction (D), th e apex of prostate (E), and the bladder neck (F) to the superior medial margin of the pubis (A), the inferior medial mar-gin of the pubis (B) and the midpoint of linear distance between the two ischial tuberosities on the perineum (C) were respec-tively measured and compared. Another 20 adult male corpses were subjected to the 3 surgical approaches as described above and the urethra was exposed to identify the tissues and organs with possible injuries resulted from the surgery, which were e-valuated by scoring.Results The distances measured were as fol lows:AD=6.5±0.5cm, BD=2.2±0.5cm, CD =3.4±0.6cm, and BDP=0.05, SN K means); AE=6.6±0.5cm, BE=3.0±0.5cm, CE=4.4±0.7cm,and BEP=0.05, SNKmeans); AF=5.7±0.6cm, BF=4.5±0.5cm, CF=6.5±0.6cm, and BFP=0.0 5,SNK means). The angles∠EAD (α₁ )=(9.3±2.0) o,∠EBD (α₂)=(17.4±3.8) o,∠ECD(α₃)=(9.2±1.6) o,showing marked difference between α₁ and α₂ (P<0.05, t=11.1) and between α₃ and α₂(P<0.05, t=12.1), but not between α₁ and α₃(P>0.05, t=0.13). The angles ∠FAE (β₁)=(22.7±2.6)°,∠FBE (β₂)=(32.9±6.4)°,∠FCE (β₃ )=(15.0±3.2)°,and β₂>β₁>β₃(P=0.05, SNK means). The score for tissue and organ injuries for the appro ach of the superior medial margin of the pubis was 13, 20 for the approach of in ferior medial margin of the pubis, and 15 for perineum approach.Conclusions In terms of operative field exposure, the best operation approach is via the infer i-or pubis, followed by superior pubis approach and perineum approach; while in view of the injuries, superior pubis approach is better than the perineum and i nferior pubis approaches. The inferior pubis approach should be the primary choi ce in the treatment of posterior urethral stricture.