输尿管镜下尿道损伤的诊治分析(附31例报道)

Diagnosis and treatment of ureteroscopy for acute urethral injury (a report of 14 cases)

目的探讨输尿管镜在急性尿道损伤中的诊断和治疗作用。方法在表面麻醉或腰麻下应用输尿管镜对31例尿道损伤进行检查和治疗,留置导尿管2～4周。4例尿道膜部损伤严重无法找到通道患者改为开放手术。术后随访12～24个月。结果 27例球部尿道损伤及膜部尿道损伤的患者经腔镜治疗后,于2～6周内全部愈合。4例开放手术的患者在术后两个月也恢复正常排尿,6例患者术后尿道狭窄行尿道内切术,2例存在勃起功能障碍。结论输尿管镜检查适用于轻中度导尿困难的尿道损伤,使用安全、术后恢复快、治愈率高,值得推广,而对于极重度尿道损伤患者建议行开放手术。

【Objective】 To evaluate the clinical efficacy of ureteroscopy for the diagnosis and treatment. 【Methods】31 cases of acute urethral injury were diagnosed and treated by ureteroscopy. 4 cases serious injury in membranous urethra that could not be found channels were changed to open surgery. Postoperative follow-up time was 12 ～24 months. 【Results】 27 cases with bulbar urethral and membranous urethral injuries were cured successfully in 2～6 weeks by endoscopic treatment. The other 4 cases of open surgery patients returned to normal voiding after 2 months. 6 patients with urethral stricture were performed direct-vision internal urethrotomy and 2 cases with serious pelvic fracture injury occurred erectile dysfunction. 【Conclusion】The ureteroscopy could be applied with mild or moderate urethral injury with catheterization difficulty. It is worthwhile to promote because of its safe apply,rapid postoperative recovery and high cure rate. However,the patients with severe urethral injury are recommended to open surgery.