小儿尿道损伤的诊断与治疗

Diagnosis and Treatment of Urethral Injury in Children

目的:探讨小儿尿道外伤及外伤后尿道狭窄的诊治经验。方法:8例新鲜后尿道断裂中,3例行经耻骨上与会阴入 路的尿道修复术、尿道会师及膀胱造瘘各2例,1例女童行经耻骨后尿道吻合术。陈旧性后尿道外伤患儿18例,其中经尿道内 切开(TUR)10例,经耻、会阴联合修复尿道及经会阴修复尿道各4例,经直肠会阴修复尿道1例。结果:8例新鲜后尿道断裂的患 儿术后出现尿道狭窄5例、不全尿失禁1例。陈旧性尿道狭窄行经尿道内切开术(TUR)的成功率为60.0％,经会阴及经耻、会 阴联合入路永道修复术的成功率为91.7％,有不全尿失禁5例,会阴尿道造瘘尚未修复1例。结论:后尿道外伤的急症处理非常 重要,如患儿情况允许应尽量行经耻、会阴联合尿道修复手术。经尿道内切开适用于绝大多数单纯性后尿道狭窄,经耻、会阴联合 或经会阴修复尿道适用于复杂性后尿道狭窄或TUR失败者。

Objective To present the experience on the diagnosis and treatment of urethral injury and traumatic posterior urethral stricture in children. Methods: In 8 cases of complete posterior urethral disruption, combined perineal-transpubic urethral repair was performed in 3 cases, urethral alignment and suprapubic cystostomy in 2 cases respectively. For 18 cases of traumatic posterior urethral stricture, treatment included transurethra resection(TUR) in 10 cases, combined perineal-transpubic urethral repair and via perineal approach for urethral repair in 4 cases respectively, urethral anastomotic repair through rectal and perineal approach in one. ResuIts:Five cases of complete posterior urethral disruption developed urethral stricture after operation, included 2 patients performed by suprapubic cystostomy, 2 patients by urethral alignment and 1 by combined perineal-transpubic urethral repair; Incomplete urinary incontinence only in 1 patient. The successful rate of TUR for treating traumatic posterior urethral stricture was 60.0%, and combined perineal-transpubic urethral repair and via perineal approach for urethral repair were 91.7%. Incomplete urinary incontinence in 5 patients after the treatment of urethral stricture, still with perineal urethrostomy in 1. Conclusion: Appropriate initial treatment is important for the management of traumatic posterior urethral injury. In fresh cases, end to end anastomosis via suparpubic combined with perineal approach should be performed in complete urethral disruption if the conditions were allowed. For old urethral injury, internal urethrotomy is good for the majority of simple stricture. Transrpubic combined with perineal approach or transperineal approach is indicated for complex posterior urethral stricture or failure with TUR.