骨盆骨折合并后尿道破裂的治疗方法及效果比较

Treatment and comparison of their effects on posterior urethral disruption associated with pelvic fractures

目的比较3种方法治疗外伤性骨盆骨折合并后尿道损伤的效果，为治疗的选择提供依据。方法总结分析98例骨盆骨折合并后尿道破裂患者的I临床治疗方法和随访结果，其中39例行早期膀胱造瘘术，延期行开放性尿道成形术；43例行早期尿道会师术；16例行Ⅰ期尿道成形吻合术。对所有患者进行尿失禁、阳痿及尿道狭窄的评估和比较。结果Ⅰ期尿道成形吻合术组尿道狭窄发生率为6％，早期行尿道会师术组为49％，而只行耻骨上膀胱造瘘的患者100％发生了尿道狭窄，后者需延期行开放性尿道成形术。阳痿和尿失禁在Ⅰ期尿道成形术患者的发生率为10％和9％；早期行尿道会师术患者的发生率分别为22％和11％；而后期行尿道成形术患者两者的发生率分别为32％和20％，较前两者高。Ⅰ期尿道成形术患者治疗过程平均经历了1．2次操作；早期行尿道会师术的患者平均经历了1．6次操作；早期膀胱造瘘延期行尿道成形术患者平均经历了3．4次操作。结论Ⅰ期尿道成形术在患者病情及医师外科技术允许的情况下可作为外伤性后尿道狭窄的首选治疗方法；早期尿道会师的效果较Ⅰ期行膀胱造瘘延期再行尿道成形术好，并发症也较少，在Ⅰ期尿道成形术不能实施的情况下尽可能早期行尿道会师术。

Objective To analyze and compare the clinical data and long-term results of follow- up of 98 patients of posterior urethral disruption associated pelvic fractures and determine the long-term results of three 3 approaches of treatments so as to provide clinical basis for selection of treatments of the disease. Methods We retrospectively reviewed the records of treatment methods and results of follow-up of 98 patients with posterior urethral disruption after blunt pelvic injury from 1980 to 2002. Of all, there 39 patients treated with early suprapubic cystostomy and delayed urethroplasty, 43 with early urethral realignment and 16 with early open urethroplasty. All patients were evaluated postoperatively for incontinence, impotence and urethral strictures. Results Diagnosis of urethral rupture was based on clinical findings and retrograde urethrography. Strictures developed in 6% of the early open urethroplasty group and in 49% of the early realignment group and in 100% of the suprapubic tube group. The incidence rate of impotence and incontinence were 10% and 9% in early open urethroplasty group, 22% and 11% in early realignment group and 32% and 20% in early suprapubic cystostomy. The incidence rate of urethral stricture, impotence and incontinence of suprapubic tube group was obviously higher than other two ap- proaches of treatments. Patients with delayed reconstruction underwent an average of 3.4 procedures compared with an average of 1.6 in the early realignment group and 1.2 procedures in the early open urethroplasty group. Conclusions When the patient＇ s condition and the doctor＇ s surgical technic are permissive, the best selection of treatment for posterior urethral disruption associated with pelvic fractures is early open urethroplasty. Early realignment may provide better outcomes than delayed open urethroplasty after posterior urethral disruption.