骨盆骨折合并后尿道损伤的早期治疗

The early treatment of posterior urethral injury associated with pelvic fractures

目的比较骨盆骨折合并后尿道损伤3种手术方式的疗效，为临床选择手术方式提供依据。方法回顾性总结分析我院1993～2008年15年间36例骨盆骨折合并后尿道损伤的手术方式与随访结果。其中行单纯膀胱造瘘6例，一期尿道吻合术4例，尿道会师牵引术26例，并对其排尿情况与有无阳痿进行分析比较。结果单纯膀胱造瘘患者均全部出现尿道狭窄式闭锁，发生率100％，需行二期尿道成形术；术后发生阳痿2例，发生率为33％；尿失禁1例。一期尿道吻合术患者，有1例出现轻度尿道狭窄，经数次尿道扩张后治愈，无尿失禁及阳痿。26例尿道会师牵引术患者，有4例发生尿道狭窄，发生率为16％，发生阳痿3例，发生率12％，1例尿失禁。结论单纯膀胱造瘘患者几乎无例外的均需行二期手术，住院时间长，并发症发生率较高。一期尿道吻合术患者，虽疗效不错，但可选择的病例有限。尿道会师牵引术，手术操作简便，损伤小，疗效好，并发症少，不失为治疗后尿道损伤早期治疗的好方法。

Objective To compare the results of three surgical treatment of posterior urethral injury associated pelvic fractures so as to povide clenical basis for selection of treatment of the disese. Methods A retrospective evaluation of the surgical treatment and results of followod up of 36 Patients with posterior urethral injuries after blunt pelvic injrty froom 1993 to 2008. Of all, there were 6 patients patients treated simple suprapubic cyststomy ,4 with early open urethroplasty and 26 with early realignment indwelling Foley＇ s catheter was used postoperative for traction. All patients were evaluated postoperatively for abnormal urination and impotence. Restilts Strietures or atresia developed in 100% of the simple suprapubie, eystostomy group and needed to the second urethroplasty. There had been 2 cases of impotence, the incidence rate was 33%. 1 case of urinary incontinence. 1 case stricture In the early open urethroplasty group and needed several dilatations. Neither incontinence nor impotence has been observed in this group. 26 with early realignment indwelling Foley＇ s catheter, Urethral stricture oecarred in 4. and incidence rate was 16%, there had been 3 cases of impotenee, the incidence rate was 12%, 1 case of incontinence. Conclusion The early realignment indwelling Foley＇ s catheter in simple, effective, nontraumafie and with less occurrence of complication. The teehnique is therefore recommended for the early surgical management of posterior urethral injure.