双镜下尿道会师术32例临床分析

Clinical analysis of 32 cases of urethral reconstruction under dual microscopes

目的探讨双镜下尿道会师术在治疗骨盆骨折后尿道断裂中的应用价值。方法回顾分析32例双镜下尿道会师术治疗骨盆骨折后尿道断裂的临床资料。结果本组32例,30例手术成功,2例改为开放手术。手术时间30~58 min,平均(35.0±4.2)min。出血50~100 mL,平均(60.2±5.3)mL。术后3个月拔除尿管后观察疗效,治愈26例,排尿通畅,无需尿道扩张;好转4例,排尿费力,尿流率下降,经间断、定期尿道扩张后排尿困难症状明显改善,尿流率基本正常,无剩余尿。其中1例术后未按医嘱行定期扩张出现尿道狭窄,行后尿道端端吻合术治愈。随访6~24个月,均排尿正常,最大尿流率13~25 mL/s,平均(20.5±1.0)mL/s,残余尿<12 mL,无性功能障碍和尿失禁。结论双镜下尿道会师术治疗骨盆骨折后尿道断裂具有出血少、安全性高、适应证更广等优势,可作为治疗骨盆骨折后尿道断裂的首选术式。

Objective To explore the application value of urethral reconstruction under dual microscopes in the treatment of posterior urethral rupture of pelvic fractures. Methods The clinical data of 32 patients with urethral reconstruction under dual microscopes in the treatment of posterior urethral rupture of pelvic fractures were analyzed retrospectively. Results Among 32 cases in this group, 30 cases had successful surgery, and 2 cases were transferred to open surgery. The surgery time was 30-58 min, with an average of（35.0±4.2） min. Bleeding was 50-100 mL, with an average of（60.2 ±5.3） mL. 3 months after removal of the urinary catheter, the efficacy was observed. 26 cases were cured, and they had unobstructed stream, with no need for urethral dilatation; 4 cases were improved, they had urination effort, with decreased urine flow rate. After intermittent and regular urethral dilatation, the symptom of dysuria was improved significantly. Urinary flow rate was normal, with no residual urine; one case showed urethral stricture due to the fact that the regular dilatation was not performed according to the doctor＇s advice, and posterior urethral end anastomosis was carried out before being cured. The patients were followed-up for 6-24 months, and all patients had normal urination. The maximum urine flow rate was 13-25 mL/s, with the average of（20.5±1.0） mL/s. The residual urine was12 mL. There were no sexual dysfunction and urinary incontinence. Conclusion Urethral reconstruction under dual microscopes in the treatment of posterior urethral rupture of pelvic fractures has the advantages of less bleeding, high safety and wider indications. It can be used as the first choice for the treatment of posterior urethral rupture of pelvic fracture.