尿道导引器在尿道会师术中的应用

Urethral Guidance Probe Applied to Surgical Urethral Realignment

目的:探索一种更安全、简便的治疗创伤性尿道断裂的手术方法。方法:对18例后尿道损伤和4例尿道球部断裂病例先作膀胱穿刺造瘘,后用尿道导引器以导引和会师的方法完成尿道会师术。结果:22例中21例完成会师手术,1例因合并膀胱破裂改为开放手术。18例硬膜外麻醉和3例局部麻醉下完成手术;平均手术时间18min,平均术中出血20ml,术后常规尿道扩张3月。21例获随访3月至2年,最大尿流率(MFR):15～22ml/s有13例,10～14ml/s有7例,1例因瘢痕狭窄术后3个月后行尿道吻合术。结论:穿刺导引法尿道会师术简便易行,减少了麻醉和术中损伤风险,可在局麻下施行,值得推广。

Objective： To search for a safe and convenient surgical method for management of urethral disruption. Methods： We performed urethral realignment for 18 cases of posterior urethral disruption and 4 cases of ruptured bulbous urethra using the urethral guidance probe following bladder puncture stoma. Results： Urethral realignment was accomplished in 21 of the cases, 18 under epidural and 3 under local anesthesia, with the mean blood loss of 20 ml and the average operation time of 18 minutes. Open surgery was necessitated in 1 ease due to the complication of bladder rupture. Routine postoperative urethral dilation extended for 3 months, and all the cases were followed up for 3 to 24 months. The maximum urine flow rate was 15 -22 ml/s in 13 cases and 10 - 14 ml/s in 7. One case received urethral anastomosis 3 months later because of urethrostenosis. Conclusions： Urethral realignment with the urethral guidance probe is a safe, convenient and effective surgical strategy for the management of urethral disruption.