男性尿道损伤早期手术方式的选择

CHOICE OF SURGICAL PROCEDURES IN THE EARLY STAGE OF THE URETHRAL INJURY OF MAN

目的探索男性尿道损伤早期最佳治疗方法。方法回顾性分析60例男性尿道损伤早期处理,球部尿道部分损伤15例,留置尿管3w治愈。球部尿道完全断裂45例,20例行Ⅰ期尿道吻合术,10例膀胱造瘘,15例行尿道会师术。结果球部尿道部分损伤患者20.0%(3/15)有轻度尿道狭窄,无阳痿发生。单纯膀胱造瘘术后尿道狭窄的发生率为100.0%,阳萎的发生率为40.0%(4/10);尿道会师及牵引术后尿道狭窄的发生率为80.0%(12/15),阳萎的发生率为26.7%(4/15);早期经会阴部Ⅰ期尿道吻合术后尿道狭窄的发生率为15.0%(3/20),阳萎的发生率为35.0%(7/20)。结论尿道部分损伤患者停留尿管效果满意;球部尿道断裂Ⅰ期尿道吻合术疗效良好,尿道会师术创伤小,如病情重则可先行单纯膀胱造瘘术。

Objective To observe the best treating method in the early stage of the urethral injury of man. Methods Retrospective analysis was done on the primary managements of 60 cases of urethral injuries of man. There were part urethrobulbar rupture in 15 cases, to them were retained urethral catheter for 3 weeks. And there were complete urethrobulbar rupture in 45 eases, among them 20 cases were given end - to - end anastomosis, cystostomy was performed in 10 cases, and internal realigment was done in 15 cases. Results The incidence of urethral stricture is 20. 0% among the part urethrobulbar rupture, and the incidence of impotence was 0%. Urethral stricture was an inevitable consequence（ 100.0% of the cases）after suprapubic cystostomy, and the incidence of impotence was 40. 0%. Primary realignment with traction decreased the incidence of stricture to 80. 0% but produced a 26.7% impotence rate. Primary suturing also decreased the incidence of stricture to 15.0%, and the incidence of impotence was 35.0%. Conclusion Part urethrobulbar rupture treated with retained urethral catheter gets good results;complete urethrohulbar rupture treated with end - to - end anastomosis also gets good results, internal realignment is less - wounded. Suprapubie cystostomy alone is indicated for critically unstable patients.