内窥镜下尿道会师术治疗尿道损伤

Treatment of urethral injury by endoscopic urethral realignment

目的比较膀胱镜下尿道会师术和开放性手术治疗尿道损伤的效果，探讨膀胱镜在急性闭合性尿道损伤治疗中的应用价值。方法选择济钢总医院1995年1月至2011年1月间收治的46例尿道损伤患者，均为男性，年龄21～53岁，其中骑跨伤致尿道球部损伤36例，骨盆骨折致后尿道损伤10例。按照入院先后分为两组，对照组为急诊行开放手术尿道会师术20例，研究组均急诊行膀胱镜下尿道会师术26例，其中置管成功24例，2例因膜部尿道完全断裂改行开放性手术。结果腔内会师组手术时间、失血量、术后住院时间、尿道狭窄发生率明显少于开放手术组（P〈0．01），两组术后最大尿流率比较差异无统计学意义（P〉0．05）。术后3～6个月评估及随访，研究组（腔内会师）尿失禁0例，阳痿2例，尿道狭窄6例；对照组（开放手术）尿失禁0例，阳痿6例，尿道狭窄12例。结论膀胱镜下尿道会师术与开放性手术相比具有手术时间短、创伤小、住院时间短、并发症少、疗效相似的特点，尤其适合球部尿道损伤的患者；腔内会师术对于治疗后尿道完全断裂需慎重，应根据伤情试行腔镜治疗，对于失败的患者仍可行开放性手术。

Objective To compare the effects of urethroscopic urethral realignment and open surgery on urethral injury and to investigate the value of cystoscope on acute closed urethral injures. Methods From Jan. 1995 to Jan. 2011 , a total of 46 patients with urethral injury were operated, including 26 cases in urethroscopic group and 20 cases in operation group. The operation duration, mean blood loss, mean hospital stay and therapeutic efficacy of these two procedures were compared. Results Twenty-four cases in urethroscopic group were successfully treated in a single session with two failure of complete membranous urethral rupture. Urethroscopic group had significantly shorter operation duration, less blood loss and shorter hospital stay than open surgery group （P 〈 0.01 ） , but there was no significant difference in maximum urine flow rate between the two groups （P 〉 0.05）. Followed up for 3 to 6 months, urinary incontinence occurred in zero case, impotence in 2 cases and urethral stricture in 6 cases in urethroscopie group, urinary incontinence occurred in zero case, impotence in 6 cases and urethral stricture in 12 cases in operation group. Conclusions Urethroseopic urethral reunion can obtain the same therapeutic effect as open surgery with shorter operation duration, simpler procedure, minimal invasiveness and less complication. Therefore we recommend this procedure as the initial step in most patients with bulbar urethral disruption, and open surgery is needed when urethroscopic surgery was failure or complete posterior urethral disruption occured.