小儿尿道损伤的诊断与治疗

The 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:在8例新鲜完全性后尿道断裂患儿中,3例行经耻骨上与会阴入路的尿道修复术,2例行尿道会师术,2例行膀胱造瘘术,1例女童行经耻骨后尿道吻合术。在18例陈旧性后尿道外伤患儿中,10例行经尿道内切开(TUR)术,4例行经耻骨、会阴联合入路修复术,4例行经会阴修复术。结果:8例新鲜后尿道断裂患儿中,术后出现尿道狭窄5例,不完全尿失禁1例。18例陈旧性尿道狭窄患儿中,行TUR的成功率为60.0%,经会阴及经耻骨、会阴联合入路行尿道修复术的成功率为91.7%,有不完全尿失禁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,应尽量行经耻骨、会阴联合入路尿道修复术。经尿道内切开适用于绝大多数单纯性后尿道狭窄,经耻骨、会阴联合入路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, urethral：anastomotic repair through transpubic approach in one girl patient. For 18 cases of traumatic posterior urethral stricture, treatment included transurethra resection （TUR） in 10 cases, combined perinealtranspubic urethral repair and via perineal approach for urethral repair in 4 cases respectively, urethral anastomotic repair through transpubic approach in one girl patient, Results：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. Conclusions： 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.