带蒂大网膜移位治疗复杂性后尿道狭窄(附六例报告)

目的　探讨带蒂大网膜移位治疗复杂性后尿道狭窄的临床疗效。　方法　复杂性后尿道狭窄 6例 ,均为男性 ,年龄 14～ 4 5岁 ,平均年龄 2 6岁。车祸伤 5例 ,坠落伤 1例。病程 6个月～ 5年 ,平均 2 .5年。狭窄段长 3.0～ 5 .5cm。合并尿道直肠瘘 2例 ,膀胱结石 1例 ,耻骨后死腔 3例。均采用经耻骨联合径路修补加带蒂大网膜移位术治疗。　结果　 6例患者均一次手术成功 ,4周后拔除导尿管均能自行排尿 ,无尿失禁及尿路感染。随访 6～ 38个月 ,平均 2 6个月。 4例排尿良好 ,不需尿道扩张 ;2例 3个月内再次出现不同程度的尿线变细、排尿困难 ,经 3～ 2 4个月的尿道扩张后治愈。　结论　带蒂大网膜移位治疗适用于尿道狭窄段较长或伴有尿道直肠瘘、假道等的复杂性后尿道狭窄 ,尤其是既往经会阴途径后尿道修复手术失败者 ,是修补复杂性后尿道狭窄较为理想的方法之一。

Pedicled greater omentum displacement for treatment of complex posterior urethral stricture(report of 6 cases)

Objective To study the therapeutic effects of pedicled greater omentum displacement for complex posterior urethral stricture. Methods This study included 6 cases (all males) of complex posterior urethral stricture.Their age ranged from 14 to 45 years with a mean of 26 years.In these cases,traffic accident injury occurred in 5 and falling injury in 1.The course of diseases ranged from 6 months to 5 years with a mean of 2.5 years.The length of stricture segment was from 3.0 to 5.5 cm.All cases were surgically treated via transpubic approach and pedicled greater omentum displacement. Results Good operative results were achieved in all 6 cases.Each of them could urinate when the catheter was taken out 4 weeks later,and no urinary incontinence,urinary tract infection were observed.All were followed up for a median period of 26 months (ranged from 6 to 38 months).4 patients had normal micturition with no need of urethral dilatation and 2 patients reencountered dysuria in 3 months and were all cured by the administration of urethral dilatation for 3 to 24 months. Conclusions This procedure has a higher success rate.It is suitable for those with complicated posterior urethral stricture,such as longer posterior urethral stricture,urethra-rectal fistula, false passage, and especially those having experienced failure of urethra repair via perineal approach. It can be regarded as one of the ideal and effective therapeutic methods for complex posterior urethral stricture.