血管保留切除术与原发性吻合术
Summary
在这里, 我们提出了一个精心制作和有效的方案, 以治疗孤立的短球茎或后尿道狭窄与血管保留切除和原发性吻合。
Abstract
尿道成形术被认为是尿道狭窄的标准治疗方法, 因为它提供了极好的长期成功率。对于孤立的短骨或后尿道狭窄, 建议通过切除和原发吻合术 (epa) 尿道成形术。由于 epa 只要求切除狭窄的部分和周围的海绵体纤维化, 一个全厚度的横截面海绵体, 在传统的横切 epa (tepa) 进行, 通常是没有必要的。约旦等人在2007年提出了一个保留血管的方法的想法, 旨在减少手术创伤, 特别是尿道的双动脉供血, 从而有可能降低术后勃起功能障碍或静脉缺血的风险。这种方法也可以是有益的后续尿道干预, 如使用游离移植重做尿道成形术, 其中一个良好的血管移植床是必不可少的。然而, 这些潜在的好处只是假设, 因为目前缺乏前瞻性研究, 将这两种技术的功能结果与经过验证的调查问卷进行比较。此外, 保血管 epa (vsepa) 至少应该能够提供类似于 tepa 的手术结果。本文的目的是给一个详细的, 一步一步的概述如何管理患者孤立的短球杆或后尿道狭窄与 vsepa。本手稿的主要目的是概述手术技术, 并报告具有代表性的手术结果。共有117名患者按照所述程序进行了管理。对整个患者群和球囊 (n = 91) 和后 (n = 26) vsepa 组分别进行了分析。球囊和后 vsepa 的成功率分别为93.4 和98.5%。总之, vsepa, 如协议中所述, 提供了良好的成功率, 低并发症率孤立的短球囊和后尿道狭窄。
Introduction
尿道成形术被认为是尿道狭窄的标准治疗方法, 因为它提供了出色的长期成功率1,2。大量的手术技术已经被描述, 挑战重建泌尿科医生选择最佳的方法, 考虑到各种严格的方式, 如限制的数量, 狭窄的长度, 狭窄的位置,病因、合群和以前的尿道干预。对于孤立的短球状尿道狭窄, 国际泌尿系统疾病咨询 (icud) 建议尿道成形术切除和原发性吻合 (epa) 与综合成功率为 93.8 3,4。
epa 的尿道成形术体现了一种方法, 即整个尿道病变段被切除, 取而代之的是健康的相邻尿道, 而不需要移植或皮瓣来弥合缝隙。传统上, 这种方法包括在狭窄5的水平上的海绵体的全厚度分割。然而, 由于 epa 只需要切除狭窄的部分和周围的海绵体纤维化, 海绵体的全厚度分割, 以及其中的双尿道血液供应, 通常是不必要的。在这一背景下, 约旦等人在2007年提出了船只省力办法的想法, 为传统的横截面环保局 (tepa)6、7提供了一种非横切的替代办法。自那时以来, 这个节省船只的 epa (vsepa) 一直在兴起, 几个中心–尽管稍作修改–在他们的手术曲目8、9、10、11 中实施了这一技术,12岁。
该技术旨在减少手术创伤, 特别是在海绵体中嵌入的尿道的双动脉供血。球囊动脉的保存有可能降低术后勃起功能障碍或缺血的风险。此外, 它可能是有益的后续尿道干预, 如使用游离移植重做尿道成形术, 其中一个良好的血管移植床是必不可少的8,9。然而, 这些潜在的好处只是假设, 因为目前缺乏前瞻性研究, 将这两种技术的功能结果与经过验证的调查问卷进行比较。
尽管功能结果很重要, 但 vsepa 至少应该能够提供与 tepa 相似的手术结果。有希望的短期结果已经公布, 并符合 icud 报告的成功率, 但迄今为止, 尚未对这两种技术进行直接比较, 3、4、8、9 10,11,12。
盆腔骨折相关的尿道损伤与瘢痕组织的形成和随后的尿道狭窄或完全闭塞的膜尿道有关。手术后或对前列腺13的照射后, 后路狭窄也可能发生。对于这些狭窄, 尿道成形术与疤痕组织的切除和球茎前列腺吻合术被推荐以及14。传统上, 球状动脉结扎在此过程中, 如果没有因为骨盆骨折已经被抹杀。为了避免这种情况, 引入并报告了一个节省船只的变种以及15,16。
本文的目的是给一个详细的, 一步一步的概述如何管理患者孤立的短球杆或后尿道狭窄与 vsepa。主要范围是概述和可视化的手术技术, 并报告具有代表性的手术结果。功能结果参数的评价超出了本文的范围。
Protocol
Representative Results
Discussion
2010年, 根特大学医院初步进行了除血管切除和原发吻合术的尿道狭窄修复术。此后, 它成为医院管理孤立的短球体或后尿道狭窄患者的实践标准。由于球茎仍然附着在会阴体上, 进入后尿道和切除该部位的纤维化组织可能会受到损害。骨盆骨折导致的拉米扭曲可能会进一步阻碍获得治疗。如果是这种情况, 由于访问不便而无法完成完全切除, 则会做出手术后的决定, 以进行与球囊动脉结扎和球茎脱离…
Disclosures
The authors have nothing to disclose.
Acknowledgements
作者没有任何承认。
Materials
| iso-Betadine Dermicum 125 ml (1) | Meda Pharma | A-472825 | |
| Sterile gown (3) | According to surgeon's preference | NA | |
| Sterile gloves (3 pairs) | According to surgeon's preference | NA | |
| Sterile drapes (4) | Medline | AGBBA073A | |
| Bard-Parker scalpel number 3 (1) | Zepf Medical Instruments | 06-1003-00 | |
| Bard-Parker scalpel number 4 (1) | KLS Martin Group | 10-100-04 | |
| Scalpel blade number 15 (1) | Swann-Morton | 0205 | |
| Scalpel blade number 24 (1) | Swann-Morton | 0211 | |
| Surgical forceps 14 cm (2) | KLS Martin Group | 12-301-14 | |
| Monopolar electrocauter Valleylab (1) | Medtronic | E2100 | |
| Electrocauter blade 15 cm (1) | Comepa | CO 150i | |
| Debakey forceps 20 cm (2) | Düfner | 06232-20 | |
| 3-layered compress 30 x 45 cm (5) | Mölnlycke Health Care | 175260 | |
| Surgical compress 10 x 10 cm (10) | Hartmann | 232088 | |
| Mayo-Hegar needle driver 18 cm (1) | Zepf Medical Instruments | 24-1804-18 | |
| Mayo-Hegar needle driver 25 cm (1) | Zepf Medical Instruments | 24-1804-25 | |
| Jones scissor 18 cm (1) | Düfner | 04940-18 | |
| Mayo-Stille scissor 17 cm (1) | Zepf Medical Instruments | 08-1700-17 | |
| Lone Star retractor (1) | CooperSurgical, Trumbull, CT, USA | 72403867 | |
| Lone Star elastic stays (4) | CooperSurgical, Trumbull, CT, USA | 3311-1G | |
| Vessel loop 45 cm (1) | Braun | 1095137 | |
| Halsted-Mosquito (6) | KLS Martin Group | 13-317-21 | |
| 20Fr silicone urethral catheter (1) | Yushin Medical Co. | 1037B-20 | |
| 3Fr ureteral catheter (1) | Teleflex | 223602 | |
| 20Fr metal sound (1) | Custom made | NA | |
| Vicryl 4-0 wire (6) | Ethicon | V734D | |
| Vicryl 3-0 wire (2) | Ethicon | VCP316H | |
| Vicryl Rapide 3-0 wire (1) | Ethicon | VF2260 | |
| 10Fr Drain needle (1) | Vygon | 658.10 | |
| 10Fr Suction drain (1) | Oriplast | 203102 | |
| Vacuum flask 400 ml (1) | Oriplast | 213215AL/QL | |
| Zetuvit 10 x 20 cm (1) | Hartmann | 413771 |
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