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经会阴球部前列腺吻合术修复骨盆骨折尿道牵张缺损及辅助操作的作用:172例患者的回顾性研究

Transperineal bulboprostatic anastomotic repair of pelvic fracture urethral distraction defect and role of ancillary maneuver: A retrospective study in 172 patients.

作者信息

Singh Santosh K, Pawar Devendra S, Khandelwal Atul K

机构信息

Department of Urology, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India.

出版信息

Urol Ann. 2010 May;2(2):53-7. doi: 10.4103/0974-7796.65104.

DOI:10.4103/0974-7796.65104
PMID:20882154
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2943680/
Abstract

OBJECTIVE

We present our experience with transperineal bulboprostatic anastomosis procedure and compare the results with age of patients, length of urethral stricture, effect of previous treatment and need for ancillary procedures.

MATERIALS AND METHODS

We retrospectively reviewed the outcome of 172 patients who underwent perineal urethroplasty procedure for traumatic stricture in our institute. Simple perineal anastomosis was done in 92 patients. Perineal anastomosis and corporal separation were done in 52 patients. Perineal anastomosis with inferior pubectomy was done in 25 patients. Perineal anastomosis with rerouting was done in three patients. Age, prior treatment, length of stricture, and ancillary techniques required during reconstruction were compiled. The clinical outcome was considered as failure when any postoperative instrumentation was needed.

RESULTS

Out of 172 cases that underwent transperineal urethroplasty procedure, 157 (91.28%) were successful. Simple perineal urethroplasty procedure showed a success rate of 93.4%, perineal anastomosis with separation of corporal bodies had a success rate of 90.4%, perineal anastomosis with inferior pubectomy had a success rate of 88% and perineal anastomosis with rerouting of urethra around the corpora had a success rate of 66.7%.

CONCLUSION

The success rate of delayed progressive perineal urethroplasty procedure for post-traumatic stricture urethra is excellent and majority of the failures occurs in prepubescent boys and in those undergoing secondary repair.

摘要

目的

我们介绍经会阴球部前列腺吻合术的经验,并将结果与患者年龄、尿道狭窄长度、既往治疗效果及辅助手术需求进行比较。

材料与方法

我们回顾性分析了我院172例因创伤性狭窄接受会阴尿道成形术患者的治疗结果。92例行单纯会阴吻合术,52例行会阴吻合术及阴茎海绵体分离术,25例行会阴吻合术及耻骨下切除术,3例行会阴吻合术及尿道改道。收集患者年龄、既往治疗情况、狭窄长度及重建过程中所需的辅助技术。若术后需要任何器械操作,则临床结果视为失败。

结果

172例接受经会阴尿道成形术的患者中,157例(91.28%)成功。单纯会阴尿道成形术成功率为93.4%,会阴吻合术联合阴茎海绵体分离术成功率为90.4%,会阴吻合术联合耻骨下切除术成功率为88%,会阴吻合术联合尿道绕阴茎海绵体重建术成功率为66.7%。

结论

创伤性尿道狭窄延迟渐进性会阴尿道成形术成功率很高,大多数失败发生在青春期前男孩及接受二次修复的患者中。

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本文引用的文献

1
Transperineal bulboprostatic anastomosis in patients with simple traumatic posterior urethral strictures: a retrospective study from a referral urethral center.单纯性创伤性后尿道狭窄患者经会阴球部-前列腺吻合术:来自一家尿道转诊中心的回顾性研究
Urology. 2009 Nov;74(5):1132-6. doi: 10.1016/j.urology.2009.05.078. Epub 2009 Aug 29.
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Gapometry and anterior urethrometry in the repair of posterior urethral defects.后尿道缺损修复中的间隙测量法和前尿道测量法
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History and evolution of transpubic urethroplasty: a lesson for young urologists in training.经耻骨尿道成形术的历史与演变:给年轻泌尿外科住院医师的一课
Eur Urol. 2007 Nov;52(5):1290-2. doi: 10.1016/j.eururo.2007.07.001. Epub 2007 Jul 6.
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Simplified reconstruction of posterior urethral disruption defects: limited role of supracrural rerouting.后尿道断裂缺损的简化重建:耻骨上改道的有限作用
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Perineal repair of pelvic fracture urethral distraction defects: experience in 120 patients during the last 10 years.骨盆骨折尿道牵张缺损的会阴修复:过去10年120例患者的经验
J Urol. 2003 Nov;170(5):1877-80. doi: 10.1097/01.ju.0000091642.41368.f5.
6
Core-through urethrotomy using the neodymium: YAG laser for obliterative urethral strictures after traumatic urethral disruption and/or distraction defects: long-term outcome.使用钕钇铝石榴石激光进行贯穿尿道切开术治疗创伤性尿道断裂和/或牵张性缺损后闭塞性尿道狭窄:长期疗效
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1-Stage delayed bulboprostatic anastomotic repair of posterior urethral rupture: 60 patients with 1-year followup.一期延迟球部-前列腺吻合术修复后尿道破裂:60例患者1年随访结果
J Urol. 2001 Feb;165(2):404-7. doi: 10.1097/00005392-200102000-00012.
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Reconstruction of posterior urethral disruption injuries: outcome analysis in 82 patients.后尿道断裂伤的重建:82例患者的结果分析
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Traumatic injuries to the urethra.尿道创伤性损伤。
J Trauma. 1981 Apr;21(4):291-7. doi: 10.1097/00005373-198104000-00006.
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Prostatomembranous urethral injuries: a review of the literature and a rational approach to their management.前列腺膜部尿道损伤:文献综述及合理的处理方法
J Urol. 1983 Nov;130(5):898-902. doi: 10.1016/s0022-5347(17)51561-x.