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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1.5～8.0 cm,平均3.6 cm。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<3 cm 者102例(53.4%),闭锁段>3 cm 者58例(30.6%)。手术总体成功率(最大尿流率>15 ml/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<3 cm 的患者为90%(92/102);闭锁段>3 cm 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<3 cm 患者疗效较好。
Objective To investigate the choice and curative effect of posterior urethral surgery. Methods The clinical data of 191 patients with posterior urethral stricture or atresia admitted to our hospital from January 1990 to January 2006 were retrospectively analyzed. Twenty-one patients underwent preoperative urethroplasty, 62 underwent urethral ultrasonography, 48 underwent urethral examination, and 4 underwent urethral magnetic resonance imaging (MRI). Twenty-six patients underwent urethral incision. Sixty-five patients underwent open surgery. Among them, 66 cases were treated by perineal urethral anastomosis, 48 cases were treated by perineal incision, 30 cases were treated by perineal resection of the inferior margin of the pubis, 18 cases of surgery, urethral drag surgery in 3 cases. The patients were followed up for 6 to 48 months with an average of 26.6 months. Results The posterior urethral stricture or atresia length of 1.5 ~ 8.0 cm, an average of 3.6 cm. There were 31 cases (16%) with posterior urethral stricture (urethral continuity survived), 160 cases (84%) with complete posterior urethra occlusion, including 102 cases (53.4%) with occlusion <3 cm and 58 cases (30.6%). The overall success rate of surgery (maximal flow rate> 15 ml / s) was 84.3% (161/191), including 69% (18/26) for urethral incision and 86.6% (143/165) for open surgery. The success rate of simple urethral anastomosis, penis transection through the perineum, perineal resection of the inferior edge of the pubis, pubic urethral anastomosis and urethral towing success rates were 97% (64/66), 79% (38 / 48), 80% (24/30), 83% (15/18) and 67% (2/3). The success rate of posterior urethral stricture (surviving urethral continuity) was 94% (29/31), 90% (92/102) in patients with <3 cm of occlusion, 69% (40% 58). Conclusion The curative effect of open surgery is better than that of urethral incision, and the curative effect of posterior urethral stricture or occlusion <3 cm is better.