后尿道狭窄外科治疗191例临床分析

目的探讨后尿道手术方法的选择及疗效。方法回顾分析1990年1月-2006年1月本院收治的191例后尿道狭窄或闭锁患者的临床资料。术前191例均行尿道造影,62例行尿道超声检查,48例行尿道镜检查,4例行尿道磁共振成像（MRI）检查。26例患者行尿道内切开;165例患者行开放性手术,其中单纯经会阴尿道吻合术66例,经会阴切开阴茎中隔48例,经会阴切除耻骨下缘30例,经耻骨尿道吻合术18例,尿道拖入术3例。术后随访6～48个月,平均26．6个月。结果后尿道狭窄或闭锁长度为1．5～8．0cm,平均3．6cm。后尿道狭窄（尿道连续性尚存）31例（16％）;后尿道完全闭锁160例（84％）,其中闭锁段〈3cm者102例（53．4％）,闭锁段〉3cm者58例（30．6％）。手术总体成功率（最大尿流率〉15ml／s）为84．3％（161／191）,其中尿道内切开为69％（18／26）,开放性手术为86．6％（143／165）。单纯经会阴尿道吻合术、经会阴切开阴茎中隔、经会阴切除耻骨下缘、经耻骨尿道吻合术及尿道拖入术的成功率分别为97％（64／66）、79％（38／48）、80％（24／30）、83％（15／18）和67％（2／3）。后尿道狭窄（尿道连续性尚存）的成功率为94％（29／31）;闭锁段〈3cm的患者为90％（92／102）;闭锁段〉3cm患者为69％（40／58）。结论开放性手术疗效优于尿道内切开,后尿道狭窄或闭锁段〈3cm患者疗效较好。

Clinical analysis of operative treatment of 191 patients with posterior urethral strictures

Objective To evaluate the various operative details of strictures of the posterior urethra that are essential for a successful result.Methods The clinical data of 191 patients with posterior urethral strictures or distraction defects from January 1990 to January 2006 were analyzed retrospectively.All patients underwent a retrograde and voiding urethrogram,62 patients had urethral ultrasonography,48 patients had urethroscopy,3 patients had MRI.Repair was performed with a simple anastomosis after urethral mobilization in 66 patients,separation of the corporeal bodies in 48 patients,separation of the corporeal bodies and inferior pubectomy in 30 patients,transpubic anastomosis in 18 patients,pull-through operation in 3 patients,and optical urethrotomy in 26 patients.Followup ranged from 6 to 48 months.Results The mean stricture length was 3.6 cm(range from 1.5 to 8.0 cm).Posterior urethral strictures is in 31(16%), posterior distraction defects is in 160(84%),of which the length of the distraction defects<3 cm is in 102 (53.4%),and the the length of the distraction defects>3 cm is in 58(30.6%).The overall successful results(Qmax>15ml/s)after operation was 84.3%.Optical urethrotomy was 69%,the successful results with anastomotic urethroplasty were 97% with a simple anastomosis;79% with separation of the corporeal bodies;80% with separation of the corporeal bodies and inferior pubeetomy;83% with transpubic anastomosis;and 67% with pull-through operation.Conclusions The anastomotic urethroplasty is better than the optical urethrotomy,the length of the strictures or distraction defect which is lower than 3 cm is much more successfully corrected.