早期处理后尿道损伤手术方法的评价

Posterior Urethral Disruption: Evaluation of Immediate Methods of Operation

目的 :对 3种手术方法治疗骨盆骨折合并后尿道断裂的疗效进行评价。方法 :对 71例男性骨盆骨折合并后尿道断裂的治疗效果及术后并发症进行回顾性分析。其中 13例单纯膀胱造瘘术后再行经会阴部尿道吻合 ,4 3例行尿道会师及牵引术 ,15例经会阴部尿道吻合。结果 :单纯膀胱造瘘术后尿道狭窄的发生率为 10 0 .0 % ,阳萎的发生率为 2 3.1% (3/ 13) ;尿道会师及牵引术后尿道狭窄的发生率为 5 8.1% (2 5 / 4 3) ,阳萎的发生率为 2 7.9% (12 /4 3) ;早期经会阴部尿道吻合术后尿道狭窄的发生率为 4 6 .7% (7/ 15 ) ,阳萎的发生率为 5 3.3% (8/ 15 ) ,尿失禁 1例(6 .7% )。结论 :单纯膀胱造瘘术适合于轻度后尿道损伤或病情危重的病人 ;尿道会师及牵引术是治疗大多数后尿道断裂病人的首选方法 ;早期经会阴部尿道吻合术则不宜提倡。

Objective The results of 3 types of initial management of pelvic fracture urethral disruption were evaluated.Methods:The records of 71 male patients with pelvic fracture urethral disruption were reviewed,13 of them were treated by suprapubic cystostomy and delayed repair,43 by primary realignment with traction and 15 by primary suturing.Results:Urethral stricture was an inevitable consequence(100% of the cases)after suprapubic cystostomy,and the incidence of impotence was 23.1%(3/13).Primary realignment with traction decreased the incidence of stricture to 58.1%(25/43)but produced a 27.9%(12/43)impotence rate. Primary suturing also decreased the incidence of stricture to 46.7% but produced the greatest complication rates for impotence(53.3%)and incontinence(6.7%).Conclusion: Suprapubic cystostomy alone is indicated for slightly urethral injury and critically unstable patients. Primary realignment with traction is preferred for more patients with pelvic fracture urethral disruption. Primary suturing is not recommended for any condition.