输尿管镜联合硅胶尿管在治疗尿道球部损伤中的应用

Application of the Ureteroscope and Silica Catheter in the Treatment of Ruptured Bulbous Urethra

目的探讨经尿道输尿管镜下行腔内会师术及术后留置硅胶尿管在治疗尿道球部损伤中的临床意义。方法回顾分析2004年1月至2006年9月本院的20例球部尿道损伤患者,采用局麻或腰麻下行输尿管镜腔内会师术及术中、术后放置硅胶尿管2～3周。结果20例中16例经尿道输尿管镜下会师成功,4例会师失败后改行开放性尿道吻合术,留置硅胶尿管,无1例并发局部感染,拔管后排尿通畅。随访3～24月,其中1例开放手术者拔管1周后尿流变细,予行5次尿道扩张后维持正常排尿,1例开放手术者并发阴茎勃起功能障碍。结论输尿管镜下尿道会师术具有手术时间短、操作方便、创伤小的特点,尤其适合于球部尿道部分断裂的患者;而采用硅胶尿管,则更易于插管及可以减少尿路感染及局部瘢痕增生,降低尿道狭窄的发生几率。

Objective To study the clinical effects of ureteroscope realignment of ruptured bulbous urethral and the silica catheter indwelled after operation. Method 20 cases of ruptured bulbous urethra with urethral reunion operation under ureteroscope from January 2004 to September 2006 were studied retrospectively.Silica catheter indwelled after operation retained 2 to 3 weeks. Result 16 cases were successful,4 cases after urethral reunion operation under ureteroscope were turned to opening urethral reunion operation, none of them had local infection. The patients had been pulled out the urethral catheter after 2 to 3 weeks, their micturition were normal. And followed up for 3 to 24 months, one case turned to opening urethral reunion operation had urethral stricture 1 week after extubation. After 5 times urethral dilatation, The patient recovered normal micturition. 1 case turned to opening urethral reunion operation had erectile dysfunction. Conclusion The technology has the advantages of shorter operation time, simple operation, less trauma complication and rapid recovery especially fitting for the patients with ruptured bulbous urethral. Moreover, by indwelling silica catheter it can reduce urethral infection and local scar hyperplasia, ultimately decreasing the incidence rate of urethral structure.