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总结经会阴后尿道狭窄/闭锁瘢痕切除+端端吻合术的临床经验,提高一次手术成功率。方法:经会阴后尿道狭窄/闭锁瘢痕切除+端端吻合术治疗骨盆骨折所致尿道损伤继发后尿道狭窄/闭锁患者76例。对于<3cm短段狭窄/闭锁者,釆用经会阴手术入路,彻底切除瘢痕,作无张力、大口径、精确吻合;对于>3cm的狭窄/闭锁者,釆用充分游离前尿道,切开阴茎海绵体间隔等辅助方法处理,以缩小尿道断端间距;术中留置后尿道U形支架管,木后持续支撑、软扩张吻合口。结果:76例均手术成功。72例(94.7%)术后膀胱尿道造影示后尿道通畅,尿流率正常。出现短暂性尿失禁8例,无永久性尿失禁。结论:经会阴瘢痕切除+端端吻合术治疗后尿道狭窄/闭锁成功率高;较长时间留置后尿道U形支架管,持续支撑、软扩张吻合口是防止狭窄复发的好方法。
To summarize the clinical experience of perineal posterior urethral stricture / atresia scar excision + end anastomosis to improve the success rate of an operation. Methods: A total of 76 patients with urethral stricture / atresia after urethral injury caused by pelvic fractures were treated with perineal posterior urethral stricture / atresia scar excision + end anastomosis. For <3cm short segment of the stenosis / occlusion, preclude the use of the perineal approach, the complete removal of the scar for tension-free, large diameter, accurate match; for> 3cm stenosis / atresia, preclude the use of adequate free anterior urethra, incision Penis cavernous space and other auxiliary methods to reduce the gap between the urethral stump; indwelling urethral U-shaped stent tube, wood continued support, soft anastomosis expansion. Results: All 76 cases were operated successfully. 72 cases (94.7%) of postoperative bladder urethroplasty showed urethral patency, normal urinary flow rate. 8 cases of transient urinary incontinence, no permanent urinary incontinence. Conclusions: The successful rate of posterior urethral stricture / occlusion after perineal scar excision + end-to-end anastomosis is high. For a long time, posterior urethral U-shaped stent tube is sustained and the soft dilation anastomosis is a good way to prevent the recurrence of stenosis.