后尿道狭窄重建无张力吻合的辅助操作

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ABSTRACT：Posteriorurethral stricture，especially bulbar and membranous urethral stricture after pelvic fracture，is the most common typeof traumatic urethral stricture.Due to the special anatomical characteristicsof the posterior urethral region ， such strictureis dificulttobetreatedwithurethralalternatives.Transperinealurethalanastomosis isthbestsurgical method，utit is dificult andriskyin patients with complicated long posteriorurethral stricture.This articlereviewes theoperations inour center，summarizes and analyzes avarietyof urethral tension-free anastomosis adjuvanttechniques.According to different stages of the surgical processthis article provides a detailed introduction tothe“pre-anastomosis”stage techniques，icluding free disectionofbulbarurethra，free disectionofdistal urethra，incisionof theseptumofcorporacavernosa，splittngof the inferior marginof the pubis；“intra-anastomosis”stage techniques，including transpositionof thecruraofcorporacavernosa penis，perineal skinflap，transposition of penis，anastomosisof bladderneck and urethra，transferof bladder flap；“postanastomosis”stage techniques，including plicationof corporacavernosa penis，suspensionofcorpora spongiosumurethra，and analyzeitsapplicationscenarios，soastoprovidereferenceforclinical practice.Inaddition，weproposeaninnovativeevaluation system，which enablessurgeons toselect differenttensionrelease techniquesaccordingtothespecificdirectionandlengthof the urethral defectto achieve anaccurate anastomosis.Thesereduction strategies cannot only promote the smooth operation of anastomosis，but also significantly reduce the recurrence rate of urethral stricture.

KEY WORDS： posterior urethral stricture；repair and reconstruction；ancillry maneuver；surgical decision；tension-fre anastomosis;pelvic fracture

摘要：后尿道狭窄，特别是骨盆骨折后导致的球膜部尿道狭窄，是外伤性尿道狭窄中最常见的类型。（剩余8575字）