骨盆骨折后尿道断裂伤的急诊救治

Emergency of posterior urethral injury complicated with pelvic fracture

目的 提高骨盆骨折后尿道断裂伤的救治水平。方法 分析总结 1 993～ 2 0 0 3年收治的骨盆骨折后尿道断裂伤 38例的急诊处理、手术方式及治疗结果。结果 对 3例部分尿道断裂伤者行单纯留置尿管3周 ,并行尿道扩张数次后 ,排尿正常。 1 8例行早期单纯尿道会师或会师牵引 ,其中 ,1 1例术后排尿正常 ,7例尿线细 ,经尿道扩张后 ,6例恢复 ,另 1例失败经再手术后治愈。 1 7例行单纯膀胱造瘘 ,分别于术后 4～ 9个月行Ⅱ期手术 ,其中 1 0例术后排尿正常 ,5例尿线细尿道扩张后恢复 ,另 2例手术失败经再次手术后治愈。发生阳痿 2例。结论 对骨盆骨折后尿道断裂伤 。

Objective To improve the emergency treatment of posterior urethral injury complicated with pelvic fracture.Methods The clinical data of 38 cases of posterior urethral injury complicated with pelvic fracture from 1993 to 2003 were analyzed including the emergency management,the surgical procedures and the results of treatment.ResultsThere were 3 cases of partial rupture were treated by simple catheterization for 3 weeks and several dilatations.Urethral realignment with or without traction were carried out in 18 cases.Good results were obtained in 11 cases with normal micturition.Severe of them,however,needed several dilatations after the initial management.One case failed was cured after re operation.Simple cystostomy was adopted in 17 cases and re operation were carried out 4 9 months later with satisfactory results and normal urination,5 of which,however,needed several dilatations.The operation failed in 2 cases.Impotence happened in 2 cases.Conclusion The early urethral realignment with or without traction could avoid re operation and certain complications.