输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗尿道断裂15例临床体会.docVIP

输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗尿道断裂15例临床体会 　　【摘要】 目的：总结输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗尿道断裂的临床体会。方法：急诊行输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗15例尿道断裂患者，总结其临床资料。结果：15例患者手术均获成功，手术时间平均（22±8）min，术中出血量平均（18±4）mL，尿管持续牵引平均（8±2）d，平均住院时间（12±2）d。术后随访12个月，治疗效果满意，未出现明显尿失禁及勃起功能损害。其中2例拔尿管后出现排尿困难，经定期尿道扩张后治愈。结论：输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗尿道断裂，操作简单，创伤小，术后恢复快，值得临床推广。 　　【关键词】 输尿管镜； 尿道会师术； 尿道断裂； 尿道狭窄 　　【Abstract】 Objective：To summarize the clinical experience of treating urethral disruption by urethral reunion traction operation in ureteroscope combined with bladder puncture fistulation.Method： 15 cases with urethral disruption who received urethral reunion traction operation combined with bladder puncture fistulation were selected and the clinical data was summarized. Result：15 cases all successed，the mean operation time was （22±8）minutes，the amount of bleeding in operation was （18±4）mL，the average time of urethral sustained traction was （8±2）days，and the hospitalization time was （12±2）days.After a follow up of 12 months，the treatment effect was satisfactory，and no obvious urinary incontinence and erectile dysfunction.2 patients with dysuria were cured by urethral dilation. Conclusion：The operation of urethral reunion traction operation in ureteroscope combined with bladder puncture fistulation to treat urethral disruption is effective for treating urethral disruption and it is worth popularizing. 　　【Key words】 Ureteroscope； Urethral reunion operation； Urethral disruption； Urethral stricture 　　First-author’s address：Zhuhai Second People’s Hospital，Zhuhai 519020，China 　　doi：10.3969/j.issn.1674-4985.2015.13.047 　　尿道断裂多因会阴骑跨伤或骨盆骨折致尿生殖膈移位，产生剪样暴力所致，其早期正确处理对预后有至关重要作用[1]。随着腔镜技术的发展，尿道损伤也进入了微创治疗时代[2-3]。自2010年以来采用急诊输尿管镜下尿道会师牵引术联合膀胱穿刺造瘘治疗15例尿道断裂患者，随访12月，临床疗效满意，现报告如下。 　　1 资料与方法 　　1.1 一般资料 本组15例患者均为男性，年龄18～58岁，平均（36±1.2）岁。受伤时间1～8 h，平均（3.5±0.5）h。均为闭合伤，其中9例为高空坠落致尿道骑跨伤：尿道球部不完全断裂6例，完全断裂3例。6例为骨盆骨折合并后尿道损伤：后尿道不完全断裂2例，完全断裂4例。阴囊和会阴血肿5例，休克3例。伤后患者均伴会阴疼痛、下腹胀痛、排尿困难、尿道滴血或渗血。入院时均不能自行排尿，急诊行诊断性导尿术均失败。所有患者除部分合并有骨盆骨折等外未发现其他严重合并伤。 　　1.2 方法