输尿管镜在尿道损伤诊断和治疗中的应用(附56例报告)

Application of ureteroscope in diagnosis and treatment of urethral injury in 56 cases

目的探讨输尿管镜技术在尿道损伤诊断和治疗中的应用。方法回顾性分析输尿管镜直视下诊断和经尿道留置导尿管治疗56例尿道损伤患者的临床效果。结果 56例患者中,诊断前尿道破裂26例,后尿道破裂11例,均成功留置导尿管;诊断前尿道断裂13例,改行尿道损伤段切除加端端吻合术;诊断后尿道断裂6例,行膀胱造瘘术。前尿道损伤患者术后3周、后尿道损伤患者术后4周拔除尿管,随访6~12个月。37例尿道破裂的患者排尿通畅,尿流率在正常范围;后尿道断裂行膀胱造瘘术的患者术后第4个月行尿道造影检查明确尿道狭窄部位后行尿道狭窄段切除加端端吻合术。结论尿道损伤患者,输尿管镜检查可简单、快速地明确损伤类型;在输尿管镜直视下留置导尿管,具有视野清楚、创伤小、并发症少的特点,是尿道破裂理想和有效的治疗方法。

Objective To explore the application of ureterscope in the diagnosis and treatment of urethral injury（UI）.Methods The clinical efficacy of transurethral catheterization under the direct vision of ureterscope in the treatment of 56 patients with UI was retrospectively analyzed.Results Among the 56 patients,26 patients and 11 patients were diagnosed as anterior and posterior urethral rupture respectively and the catheters were placed successfully.Thirteen patients with anterior urethral disruption were converted to the removal of injured urethra combined with end-to-end anastomosis while 6 patients with posterior urethral disruption were received cystostomy.The catheters were removed 3 weeks later for anterior urethral injury and 4 weeks later for posterior urethral injury postoperatively,the follow-up went for 6~12 months.Thirty-seven patients who were diagnosed as urethral rupture voided well with a normal urine flowing rate while 6 patients who underwent cystostomy were performed the removal of strictured urethra combined with end-to-end anastomosis after employing cystourethrography to confirm the strictured part in the 4th month postoperatively.Conclusion Ureterscopy is helpful in diagnosing UI easily and quickly.With the advantages of clear vision,little disturbance and quick recovery,catherization under the direct vision of ureterscope is effective in the treatment of urethral rupture disruption.