尿道损伤134例

Diagnosis and treatment of urethral injury:a report of 134 cases

目的 总结近十年来各种类型尿道损伤的诊治经验。 方法 回顾分析了 134例尿道损伤的临床分型及其诊断和治疗 ,并对其中 6 7例 (4例为女性 )的治疗效果进行了随访。 结果 男性Ⅱ、Ⅲ型损伤和Ⅳ型损伤的术后尿道狭窄的发生率分别为 19% (7/ 36 )和 44 % (12 / 2 7) ,两组差异有显著性意义 (P <0 .0 5 ) ;阳痿的发生率分别为 2 5 % (9/ 36 )和 44 % (12 / 2 7) (P <0 .0 1) ;尿失禁的发生率分别为 0和 11% (3/ 2 7)。对于后尿道损伤者 ,尿道会师术和Ⅱ期尿道端端吻合术术后尿道狭窄的发生率分别为 5 0 % (5 / 10 )和 43% (6 / 14) ,两者之间差异无统计学意义 (P >0 .0 5 )。 结论 Ⅳ型损伤最易引起术后尿道狭窄 ,阳痿的发生率亦较高 ;对于尿道损伤 ,尤其是后尿道 ,应根据不同的损伤类型及伤情而采用不同的处理方法 ;尿道内切开术是治疗创伤性尿道狭窄的理想方法。

Objective To summarize the experience in the management of urethral injuries in the latest decade. Methods In this series, 134 patients with urethral injure were analyzed for their clinical types, diagnosis and treatments, 67 of whom were followed up to assess the effect of the treatment. Results The postoperative occurrence rates of urethral stricture in the injury of the anterior urethra (Types Ⅱ and Ⅲ) and in the posterior urethra (Type Ⅳ) were 19%(7/36) and 44%(12/27), respectively ( P <0.05). The occurrence rates of impotence in these two groups were 25%(9/36) and 44%(12/27), respectively ( P <0.01), and the rates of urinary incontinence were 0 and 11%(3/27), respectively. With regard to the posterior urethral injury resulted from pelvic fractures, there is not significant difference among the occurrence rates of urethral stricture and urinary incontinence among three kinds of treatment methods (urethra reunion, primary suturing and delayed repair). Conclusions Posterior urethral (Type Ⅳ ) injury has a much higher incidence of postoperative urethral stricture and impotence than other types of injury. As to urethral injury, especially posterior urethral injury, the option of treatments should be based on the types of the injury and other injury conditions. Internal urethrotomy under endoscope is a preferable method for the treatment of urethral stricture.