经会阴球膜部尿道吻合术治疗骨盆骨折所致后尿道狭窄的术后并发症回顾性研究

目的:回顾性研究骨盆骨折所致的后尿道狭窄而采用经会阴途径球膜部端端吻合尿道成形术患者的术后并发症。方法:本研究对象为573例因骨盆骨折导致的后尿道狭窄患者,均接受经会阴途径球膜部尿道吻合术,联合逆行和顺行膀胱尿道造影对狭窄长度、部位和程度进行评估。所有患者行经会阴途径一期尿道吻合成形术。以患者术后排尿通畅并且不需要其它干预措施作为手术成功的标志。使用国际勃起功能指数(IIEF)-5问卷调查对术前和术后性功能障碍的患病率进行评估,利用尿垫试验对压力性尿失禁的程度进行评估。结果:573例患者中,504例(88%)成功,69例(12%)不成功。手术后4周去除导尿管,测定尿流率平均最大为(20.52±5.1)ml/s。28例术中直肠损伤并一期修复。10例(1.7%)在术后6个月内尿道狭窄复发,45例在术后6个月~1年期间尿道狭窄复发。所有复发患者接受了再次手术。24例(4.2%)有轻度急迫性尿失禁,28例(4.9%)有轻度压力性尿失禁。术前有487例患者(85%)在受伤后出现勃起功能障碍,术后有492例(86%)发生勃起功能障碍,但术前和术后比较,差异无统计学意义(P0.05)。9例(1.6%)发现在后尿道与膀胱颈之间存在假道。结论:若术前进行谨慎评估,明确解剖结构,术中精细操作,经会阴途径球膜部尿道吻合术相关的大部分并发症是可以避免的。

Retrospective study on complications following transperineal bulboprostatic anastomosis for posterior urethral strictures resulting from pelvic fracture

Objective.. To study the complications of transperineal end-to-end anastomotic urethroplasty in pa- tients with posterior urethral strictures resulting from pelvic fracture. Method.. Five hundred and seventy-three pa- tients who underwent bulboprostatic anastomosis because of posterior urethral strictures were enrolled in this stud- y. Distraction defects were measured by retrograde urethrography combined with voiding cystourethrography. All patients underwent perineal excision and primary anastomotic urethroplasty. The urethroplasty was considered successful if the patient was free from stricture-related obstruction and did not require any further intervention. The prevalence of pre-and postoperative sexual disorders was investigated using the International Index of Erectile Function （IIEF）-5 questionnaire. The degree of stress incontinence was assessed daily by pad testing. Result.. Of 573 bulboprostatic anastomosis procedures performed, 504 （88 %） were successful and 69 （12 %） were not suc- cessful. Average maximal flow rate assessed by uroflowmetry four weeks after surgery was （20.52 i 5.1） ml/s. Intraoperative rectal injury was repaired primarily in 28 cases. Recurrence of urethral strictures was observed in 10 patients （1.7 ~） during the first six months after surgery, and in 45 patients from half to one year. All the recur- rent patients underwent reoperation. Twenty-four patients （4.2%） had mild urge incontinence and 28 （4. 9 %） had mild stress incontinence. Erectile dysfunction was found in 492 cases （86%） after the operation and in 487 cases （85%） before the operation. There was no statistical difference between the incidences of preoperative and postoperative erectile dysfunction （P〉0.05）. Nine cases （1.6%） were found to have false passages between the posterior urethra and bladder neck. Conclusion.. Major complications of transperineal bulboprostatic anastomosis can be avoided as long as meticulous preoperative evaluation to define the anatomy and careful intraoperative manipulation are guaranteed.