端端吻合

  • 介绍
  • 讲座
  • 论文
  • 常见问题与解答
  • 成果展示
  • 外科操作技巧
“端端吻合”技术是将尿道狭窄段切开，切除疤痕组织再行尿道端端吻合，是最早开展的尿道狭窄修复手术之一。

anastomosi-1

图 1
anastomosi-2

图 2
anastomosi-3

图 3
anastomosi-4

图 4

一般来讲，手术有两种方式：

  • 端端吻合。完全切除狭窄段尿道，将剩余正常尿道直接进行吻合，保证内径（图1,2）。
  • 借助皮肤和口腔黏膜的端端吻合。完全切除狭窄尿道，借助移植物对尿道进行吻合，保证内径（图3,4）。

 

端端吻合手术适用于以下人群：

  • 外伤性尿道球部损伤造成的狭窄，长度不超过2cm；
  • 接受过前期尿道狭窄手术，但由于瘢痕增生导致失败，狭窄长度不超过2cm。
论文 1

Barbagli G, Palminteri E, Bartoletti R, Selli C, Rizzo M.
Long-term results of anterior and posterior urethroplasty with actuarial evaluation of the success rates.
J Urol. 1997 Oct;158(4):1380-2.

Purpose: We analyzed the long-term results of different urethroplasty techniques.
Materials and Methods: We performed a retrospective review of 98 patients who underwent different procedures for anterior (78) and posterior (20) urethral strictures. Mean followup was 53 months. A total of 20 patients underwent end-to-end anastomosis (group 1), 30 underwent 1-stage procedures (group 2), 28 underwent 2-stage procedures (group 3), and 20 underwent bulboprostatic anastomosis (group 4). The results were analyzed using Kaplan-Meier curves and log rank test.
Results: The success rate was 95% for group 1, 93.4% for group 2, 78.6% for group 3, and 70% for group 4. Statistical evaluation of the actuarial success rates failed to show significant differences among the 4 groups.
Conclusions: The stricture recurrences were uniformly distributed over time. Urethroplasty patients must be followed for the rest of their lives.
论文 2

Barbagli G, Palminteri E, Lazzeri M, Guazzoni G, Turini D.
Long-term outcome of urethroplasty after failed urethrotomy versus primary repair.
J Urol. 2001 Jun;165(6 Pt 1):1918-9.

Purpose: A urethral stricture recurring after repeat urethrotomy challenges even a skilled urologist. To address the question of whether to repeat urethrotomy or perform open reconstructive surgery, we retrospectively review a series of 93 patients comparing those who underwent primary repair versus those who had undergone urethrotomy and underwent secondary treatment.
Materials and Methods: From 1975 to 1998, 93 males between age 13 and 78 years (mean 39) underwent surgical treatment for bulbar urethral stricture. In 46 (49%) of the patients urethroplasty was performed as primary repair, and in 47 (51%) after previously failed urethrotomy. The strictures were localized in the bulbous urethra without involvement of penile or membranous tracts. The etiology was ischemic in 37 patients, traumatic in 23, unknown in 17 and inflammatory in 16. To simplify evaluation of the results, the clinical outcome was considered either a success or a failure at the time any postoperative procedure was needed, including dilation.
Results: In our 93 patients primary urethroplasty had a final success rate of 85%, and after failed urethrotomy 87%. Previously failed urethrotomy did not influence the long-term outcome of urethroplasty. The long-term results of different urethroplasty techniques had a final success rate ranging from 77% to 96%.
Conclusions: We conclude that failed urethrotomy does not condition the long-term result of surgical repair. With extended followup, the success rate of urethroplasty decreases with time but it is in fact still higher than that of urethrotomy.
论文 3

Guido Barbagli, Michele De Angelis, Giuseppe Romano and Massimo Lazzeri
Long-Term Followup of Bulbar End-to-End Anastomosis: A Retrospective Analysis of 153 Patients in a Single Center Experience
J Urol 2007; 178: 2470-2473

Purpose: We performed a retrospective evaluation and statistical analysis of outcome in patients who underwent bulbar end-to-end anastomosis.
Materials and Methods: We reviewed 153 patients with an average age of 39 years who underwent bulbar end-to-end anastomosis between 1988 and 2006. Mean followup was 68 months. Stricture etiology was unknown (62.7%), catheter (14.4%), blunt perineal trauma (11.7%), instrumentation (9.8%), radiotherapy (0.7%) and infection (0.7%). Stricture length was 1 to 2 cm (in 59.5%), 2 to 3 cm (37.9%), 3 to 4 cm (1.9%) or 4 to 5 cm (0.7%). A total of 90 patients (59%) underwent dilation, internal urethrotomy, urethroplasty or multiple procedures before being referred to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. The prevalence of postoperative sexual dysfunction was investigated using a nonvalidated questionnaire.
Results: Of 153 cases 139 (90.8%) were successful and 14 (9.2%) were treatment failures. Treatment failure was managed with urethrotomy in 9 cases, end-to-end anastomosis in 2, buccal mucosal graft urethroplasty in 1 and 2-stage repair in 2. Of 14 cases of failure 12 had a satisfactory final outcome, 1 is still waiting for the second stage of urethroplasty and 1 underwent definitive perineostomy. There were 14 patients (23.3%) who experienced ejaculatory dysfunction, 1 (1.6%) a cold glans during erection, 7 (11.6%) a glans that was neither full nor swollen during erection and 11 (18.3%) had decreased glans sensitivity. No patients complained of penile chordee or impotence.
Conclusions: Bulbar end-to-end anastomosis has a success rate of 90.8%. Most patients were satisfied with the surgical outcome despite postoperative complications such as ejaculatory dysfunction, a glans that was neither full nor swollen during erection, or decreased penile sensitivity.
1. 问: 此项手术使用什么麻醉方式？
答: 经口气管插管的全身麻醉。

2. 问: 手术时间多长？
答: 约2小时。

3. 问: 手术后是否有勃起、生育问题或者尿失禁的风险？
答: 没有。

4. 问: 手术后住院时间是多长？
答: 一般来讲，5到7天

5. 问: 术后多长时间可以拔除尿管？
答: 至少保留至术后4周,待术后首次尿路造影结果正常后拔除。

6. 问: 恢复期有什么特别需要注意的问题么？
答: 在恢复期，抗生素的使用一般持续到尿管拔除以后。同时，长途坐车旅行，重体力劳动、性生活以及运动是暂时需要避免的。

7. 问: 术后什么时候可以恢复工作、性生活以及运动？
答: 在拔除尿管的一个月后，根据情况逐步恢复即可。

8. 问: 手术以后是否可以立即骑自行车或摩托车？
答: 不建议术后立即进行骑车、骑马等运动。

9. 问: 术后饮食需要注意些什么？
答: 避免啤酒以及烈性酒精饮品，巧克力，可可，坚果和贝类不要多吃。