复杂器质性尿道狭窄行尿道扩张并发直肠损伤8例分析

Organic Complex Urethral Stricture Urethral Dilation Concurrent Rectal Injury in 8 Cases

目的:探讨复杂器质性尿道狭窄行尿道扩张并发直肠损伤发生的原因、诊治及预防。方法:对笔者所在医院2000年1月-2015年1月收治的复杂器质性尿道狭窄行尿道扩张术并发直肠损伤的8例患者进行回顾性分析。结果:8例术中均在斑马导丝引导下留置尿管。1例行乙状结肠造口,一期直肠创口清创缝合;3例行剖腹探查,腹膜未受损伤,腹腔均未受手术污染,未行结肠造口;4例未行剖腹探查,未行结肠造口。8例留置尿管9周后,拔出尿管,均未出现尿道直肠瘘,8例预后均良好。结论:复杂器质性尿道狭窄行尿道扩张并发直肠损伤多在术中发现,暴力操作是主要原因。对于未损伤腹膜、未贯穿腹腔、肠道清洁的患者,可留置尿管观察,必要时行直肠创口清创缝合术和结肠造口术,术后给予胃肠道减压、积极抗炎、肠外营养,预后均良好。严格把握尿道扩张适应证,规范操作是预防直肠损伤的关键。对于狭窄段较长者,建议行尿道狭窄段切除端端吻合术或者经尿道尿道狭窄段内切开术。

Objective：To investigate the reason of rectal injury,diagnosis,treatment and prevention of complex organic urethral dilation urethral stricture.Method：From January 2000 to January 2015,eight cases with complex organic urethral stricture concurrent rectal injury in our hospital were retrospectively analyzed.Result：8 cases were all in zebra indwelling catheter guide wire under.A routine colostomy,a rectal wound debridement,3 routine laparotomy,peritoneal intact,abdominal surgery were not affected by pollution,did not undergo colostomy,four cases did not undergo laparotomy,did not undergo colostomy mouth.After nine weeks indwelling catheter,pull out the catheter,no urethral fistula,eight cases the prognosis were good.Conclusion：Organic complex urethral stricture urethral dilation multiple concurrent rectal injury during surgery is found that violent action,it is the main reason.For not damage the peritoneum,not through the abdominal cavity in patients with bowel cleansing can observe indwelling catheter,if necessary,rectal wound debridement surgery and colostomy,after giving gastrointestinal decompression,positive anti-inflammatory,bowel nutrition,the prognosis is good.Strictly control urethral indications and standards are key to preventing rectal injury.For the stricture is longer,it is recommended urethral stricture resection anastomosis or transurethral incision of urethral stricture.