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目的探讨采用带蒂腹直肌瓣夹压悬吊球部尿道治疗男性获得性尿失禁的可行性和有效性。方法取10只成年雄性比格犬带蒂腹直肌,长约8．0 cm,宽约2．5 cm,包绕球部尿道处阴茎1周,术前、术中、术后1个月、2个月分别测定尿道压力变化。临床采用带蒂腹直肌瓣悬吊球部尿道治疗2例男性复杂性尿道狭窄术后压力性尿失禁。结果犬使用腹直肌包绕阴茎后及术后2个月,最大尿道内压分别为(78．3±20．5)cm H2O(1 cm H2O=0,098 kPa)和(88．3±22．4)cm H2O,与术前(48．9±11．0)cm H2O相比差异均有统汁学意义(t=4．995,P=0．0007和t=6．058,P= 0．0002)。临床2例采用带蒂腹直肌瓣悬吊球部尿道术后7 d拔除导尿管,1例排尿通畅,另1例排尿困难,再次留管1周后排尿通畅。术后分别于10个月、1年随访,1例控尿较术前明显改善,另1例完全控尿,术后最大尿流率分别为25 ml／s和34 ml／s。结论采用带蒂腹直肌瓣夹压悬吊球部尿道能明显提高尿道压力,为治疗男性尿失禁增加了一种新的术式。
Objective To investigate the feasibility and effectiveness of pediatric urethral obstruction treated with pedicled rectus abdominis flap. Methods Ten adult male beagle pedicled rectus abdominis rectus, about 8.0 cm long and 2.5 cm wide, were enrolled in the penis of the urethra at the bulb for 1 week. The preoperative, intraoperative and postoperative months , 2 months were measured urethral pressure changes. Clinical use of pedicled rectus abdominis flap for bulbous urethra treatment of 2 cases of male complicated urethral stricture postoperative stress urinary incontinence. Results The maximal urethral pressure was (78.3 ± 20.5) cm H2O (1 cm H2O = 0,098 kPa) and (88.3 ± 22) mm after rectus abdominis wrapped around penis and 2 months after operation. 4) cm H2O, which were significantly different from those of preoperative (48.9 ± 11.0) cm H2O (t = 4.995, P = 0.0007 and t = 6.058, P = 0 .0002). Two cases of clinical use of pedicled rectus abdominis flap lobectomy 7 days after the removal of the catheter, one case of voiding patency, and the other 1 case of dysuria, urination after 1 week of rectal retention. The patients were followed up for 10 months and 1 year respectively. One case of controlled urination was significantly improved compared with that before operation. The other one was completely controlled by urine. The maximal urine flow rate after operation was 25 ml / s and 34 ml / s respectively. Conclusions The use of the pedicled rectus abdominis flap to clamp the bulb urethra can significantly increase the urethral pressure and add a new operation for the treatment of male incontinence.