骨盆骨折致后尿道损伤的手术方式选择与疗效评价

Surgical selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture

目的:探讨骨盆骨折致后尿道损伤的外科术式选择及手术治疗的临床效果。方法:自2000年6月至2010年8月,回顾性分析72例骨盆骨折合并后尿道损伤患者的临床资料,其中男46例,女26例;年龄26～62岁,平均35.2岁;受伤至入院时间1～3h。按Tile骨盆骨折分类:A型8例,B型45例,C型19例。35例尿道部分断裂患者中,30例行导尿术,5例行Ⅰ期尿道断端吻合术联合膀胱造瘘术;37例尿道完全断裂患者中,25例行早期尿道会师术,12例行单纯膀胱造瘘术。对所有患者进行尿失禁、阳痿及尿道狭窄的评估和比较。结果:72例患者均获得随访,时间5～10年,平均7.7年。膀胱造瘘术患者尿道狭窄、阳痿和尿失禁的发生率显著高于Ⅰ期尿道断端吻合术者和早期行尿道会师术者(P<0.05);导尿术患者尿道狭窄、阳痿、尿失禁的发生率均远低于其余3组(P<0.05)。结论:对于后尿道部分断裂患者,导尿术或Ⅰ期尿道断端吻合术应首先考虑;而对于后尿道完全断裂患者,早期尿道会师术操作简单、并发症少,可作为首选治疗方法。

Objective ：To explore selection and efficacy assessment for membranous urethral trauma caused by pelvic fracture. Methods：From June 2000 to August 2010,72 patients with membranous urethral trauma caused by pelvic fracture were selected. There were 46 males and 26 females,ranging age from 26 to 62 years （averaged 35.2 years）. The time from injURY to hospitalization time was 1 to 3 hours. According to Tile pelvic fracture classification, there were 8 patients with type A, 45 patients with type B, 19 patients with type C. Thirty of the 35 patients with partial rupture of posterior urethral were treated by catheterization,5 patients treated by rupture anastomosis on the stage I combined with cystostomy;25 of the 37 patients with complete rupture of posterior urethra were treated by early realignment, and 12 patients were treated by cystostomy. Urinary incontinence,impotence and urethrostenosis were evaluated. Results：All patients were followed up for 5 to 10 years （mean 7.7 years）. Incidence of urethrostenosis, impotence and urinary incontinence in patients treated by cystostomy were sig- nificantly higher than rupture anastomosis on the stage I and early realignment （P〈0.05） ;while incidence in patients treated by catheterization was significantly lower than other groups （P〈0.05）. Conclusion：For patients with partial rupture of posterior urethral, catheterization and rupture anastomosis on the stage I are preferred methods; while patients with complete rupture of posterior urethra, early realignment is a preferred method with advantages of simple operation and less complications.