七年制医学课件专外31urethraltrauma.pptxVIP

Urethral trauma（尿道损伤）童成医科力修附一沆洒尿外科 尹志康Urethral anatomy尿道解剖复习pendulous portion 悬垂部尿道a厂anterior urethr 前尿道bulbous portion. 八J (genitourinary diaphragm)球部尿道male urethra，(尿生殖膈)membranous portionT膜部尿道 posterior urethra后尿道prostatic portion前列腺部尿道BladderProstateRectumCorpusFossa navicularis、Scrotal septumInjuries of the anterior urethra前尿道损伤is the most common injured area in the anterior urethraCauses of injury （致伤原因）? Straddle injuries 骑跨伤? Direct blow to the perineum会阴部暴力击伤? Other causes: penetrating wound, iatrogenic instrumentation 枪弹丿J伤，医源性损 伤Straddle injury falling astride a postPathology（病理）1、classifications （种类型）? contusion of urethra尿道挫伤? laceration of urethra尿道破裂? disruption of urethra尿道断裂Contusion of urethra 尿道挫伤pathology 病理2、pathological stages病理分期According to the pathological changes, the course of disease consist of 3 stages: 按损伤后不同时期的病理变化分三期injury stage ( within 72 h)损伤期(伤后72小 时内) WWW Hnpin POm inflammation stage (after 72h to 3 weeks) 炎症期(伤后72小时?3周)stricture stage (after 3 weeks)狭窄期(伤后3 周以后)Pathology:urinary extravasation and hematoma尿外渗及血肿confined by bucks fascia局限于阴茎injuries of anterior urethra 前尿道损伤阴茎筋膜完整阴茎筋膜破裂confined by collesfascia 会阴浅袋The ranges of extravasatio前尿道损伤的尿外渗范围：bucks fascia is intact 阴茎筋膜完整bucks fascia is not intact 阴茎筋膜不完整Confined by bucks fasciaConfined by collesfasciaclinical pictures showing range of extravasation and hematomsClinical manifestations临床表现? 1. bleeding from the urethra 尿道出血? 2. Difficulty of urination and urinary retention排尿困难、尿潴留? 3. local pain of perineum 局部疼痛? 4. perineal hematoma and contusion 局部血肿和淤斑■ V Wl I I ■ WW I I 1? 5. urinary extravasation 尿外渗,Diagnosi s 诊断? History and clinical manifestations病史与临床表现（骑跨 伤史、尿道流血、会阴部血肿、尿外渗分布）? catheterization for diagnostic purpose诊断性导尿? retrograde urethrography逆行尿 道造影Catheterization for diagnostic purpose诊断性导尿? Indications: urethral injuries are suspected . 2、any injury associated with difficulty of urination and urinary retention. 适应症：1.怀疑尿道损伤.2.损伤后有排尿困难、尿潴留? methods: to gently