输尿管镜微创治疗尿道损伤61例分析

Clinical application of endoscopic treatment in patients with early urethral injury

目的:探讨输尿管镜微创治疗在尿道损伤中的临床应用。方法:对61例急性尿道损伤患者在输尿管镜直视下,将导丝从尿道口插入膀胱,在导丝的引导下将导尿管插入膀胱,完成尿道会师。结果:所有手术均顺利完成,治疗3～4周后对患者进行全面的评估,决定是否拔除导尿管,并定期做尿道扩张。平均随访6个月至3年,其中8例患者出现严重的尿道狭窄,其他患者排尿通畅,膀胱镜检显示:患者尿道断端愈合较好,未见狭窄或出现轻度狭窄。8例患者给予尿道冷切术切开瘢痕狭窄段后排尿通畅,并嘱患者定期进行尿道扩张治疗。并发骨盆骨折患者中2例术后出现性功能障碍。结论:对尿道损伤患者早期行输尿管镜治疗,临床效果好,并发症少。

Objective ：To investigate the clinical application of endoscopic treatment in patients with early urethral injury. Methods： 61 patients with early urethral injury were enrolled from October 2007 to August 2010 in our hospital, ureteroscope under direct vision into the mirror from the urethral orifice proximal to the urethra into the guide wire injury, the introduction of the catheter into the blaldder, complete urethral realignment. Results： All of operations completed successfully. After 3-4 weeks, comprehensive assessment was given to patients and decided whether the catheter needing to removed, urethral dilatation at regular intervals. We found that 8 patients emerged with dominant urethral stricture after 6 months to 3 years follow-up; others were normal, the stump healed well, no stenosis or mild stenosis were founded under cystoscopy direct vision. 8 patients became smooth voiding after implementation of plasma incision. Sexual function evaluation found that 2 of pelvic fracture patients were sexual dysfunction. Conclusion： Application of endoscopic treatment in patients with early urethral injury have a good clinical effect, less complication and extensive clinical practical value.