前列腺癌根治术后吻合口狭窄。发病率、表现及治疗
Anastomotic stricture after radical prostatectomy. Incidence, findings and treatment.
作者信息
Popken G, Sommerkamp H, Schultze-Seemann W, Wetterauer U, Katzenwadel A
机构信息
Department of Urology, University Hospital of Freiburg, Germany.
出版信息
Eur Urol. 1998;33(4):382-6. doi: 10.1159/000019620.
OBJECTIVES
Stricture of the vesico-urethral anastomosis is a well-known complication after radical prostatectomy. Dilatation, stricture incision or resection have been proposed for endoscopic treatment.
METHODS
In a retrospective study of 340 patients with prostatic cancer who underwent a radical retropubic prostatectomy from 1988 until 1996, we looked at the incidence of anastomotic strictures.
RESULTS
An anastomotic stricture was found in 24 cases (7%) requiring endoscopic treatment. Based on prospective X-ray studies, we were able to show that the site of stricture is located below the bladder neck musculature in most cases well above the distal urethral sphincter and pelvic floor. No continence problems were encountered following structure resection in a follow-up of 12-72 months determined by a questionnaire and pad test.
CONCLUSION
The transurethral resection of anastomotic stricture allows for a rather generous tissue resection, which is preferable to incision or dilatation in our hands.
目的
膀胱尿道吻合口狭窄是根治性前列腺切除术后一种众所周知的并发症。已提出采用扩张、狭窄切开或切除等方法进行内镜治疗。
方法
在一项对1988年至1996年间接受耻骨后根治性前列腺切除术的340例前列腺癌患者的回顾性研究中，我们观察了吻合口狭窄的发生率。
结果
发现24例（7%）出现吻合口狭窄，需要进行内镜治疗。基于前瞻性X线研究，我们能够表明，在大多数情况下，狭窄部位位于膀胱颈肌肉组织下方，远高于尿道远端括约肌和盆底。通过问卷调查和尿垫试验进行12至72个月的随访发现，狭窄切除术后未出现控尿问题。
结论
经尿道切除吻合口狭窄可进行较为广泛的组织切除，在我们看来，这比切开或扩张更为可取。
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