经会阴途径后尿道端端吻合术治疗创伤性后尿道狭窄37例

目的探讨经会阴途径后尿道端端吻合术治疗创伤性后尿道狭窄的临床疗效。方法 37例创伤性后尿道狭窄患者术前均常規行膀胱尿道造影,复杂病例加行尿道B超、多层CT尿道重建（CTU）、磁共振尿道成像（MRU）及尿道镜或软性膀胱镜检查。37例患者均行经会阴途径后尿道端端吻合术,其中单纯尿道端端吻合术11例,阴茎海绵体中隔切开＋后尿道端端吻合术23例,阴茎海绵体中隔切开＋耻骨下缘楔形切除＋后尿道端端吻合术3例。结果 37例患者术后随访3~20个月,平均12.3个月,术后最大尿流率为13.3~51.2 mL.s-1,平均（21.81±8.04）mL.s-1。手术总的成功率为86.5%（32/37）,其中经会阴单纯尿道端端吻合术的成功率为90.9%（10/11）,阴茎海绵体中隔切开＋后尿道端端吻合术的成功率为86.9%（20/23）,阴茎海绵体中隔切开＋耻骨下缘楔形切除＋后尿道端端吻合术的成功率为66.7%（2/3）;手术不成功5例（13.5%）。结论经会阴途径后尿道端端吻合术可有效治疗创伤性后尿道狭窄。

Transperineal Posterior Urethra End-to-end Anastomosis to Treat 37 Cases with Traumatic Posterior Urethral Stricture

Objective To explore the clinical curative effect of transperineal urethra end-to-end anastomosis on traumatic posterior urethral stricture.Methods Thirty seven patients of traumatic posterior urethral stricture were evaluated preoperatively by cystourethrography and urethral ultrasonography,and several complicated patients underwent CTU,MRU,urethroscopy and flexible cystoscopy.Transperineal urethra end-to-end anastomosis were performed to all 37 patients：11 patients underwent simple urethra end-to-end anastomosis,23 patients underwent separation of the corporeal bodies and urethra end-to-end anastomosis,3 patients underwent separateon of the corporeal bodies and inferior pubectomy and urethra end-to-end anastomosis.Results 37 patients were followed up about 3 to 20 months,average 12.3 months.Qmax of all patients ranged from 13.3 to 51.2 mL·s-1,average（21.81±8.04）mL·s-1.Total successful rate of operations were 86.5%（32/37）.The successful rate of simple urethra end-to-end anastomosis was 90.9%（10/11）,and that of separation of the corporeal bodies and inferior pubectomy was 86.9%（20/23） and 66.7%（2/3） respectively.Five cases failed（13.5%）.Conclusion Traumatic posterior urethral stricture can be effectively treated by transperineal urethra end-to-end anastomosis.