雙鏡下尿道會師術32例臨床分析

劉光泉

[摘要] 目的 探討雙鏡下尿道會師術在治療骨盆骨折后尿道斷裂中的應用價值。 方法 回顧分析32例雙鏡下尿道會師術治療骨盆骨折后尿道斷裂的臨床資料。 結果 本組32例，30例手術成功，2例改為開放手術。手術時間30～58 min，平均（35.0±4.2）min。出血50～100 mL，平均（60.2±5.3）mL。術后3個月拔除尿管后觀察療效，治愈26例，排尿通暢，無需尿道擴張；好轉4例，排尿費力，尿流率下降，經間斷、定期尿道擴張后排尿困難癥狀明顯改善，尿流率基本正常，無剩余尿。其中1例術后未按醫囑行定期擴張出現尿道狹窄，行后尿道端端吻合術治愈。隨訪6～24個月，均排尿正常，最大尿流率13～25 mL/s，平均（20.5±1.0）mL/s，殘余尿<12 mL，無性功能障礙和尿失禁。 結論 雙鏡下尿道會師術治療骨盆骨折后尿道斷裂具有出血少、安全性高、適應證更廣等優勢，可作為治療骨盆骨折后尿道斷裂的首選術式。

[關鍵詞] 后尿道斷裂；尿道會師術；軟性膀胱鏡與硬性輸尿管鏡

[中圖分類號] R699 [文獻標識碼] B [文章編號] 1673-9701（2017）29-0053-03

Clinical analysis of 32 cases of urethral reconstruction under dual microscopes

LIU Guangquan

Department of Urinary Surgery， Zouping County Peoples Hospital in Shandong Province， Zouping 256200， China

[Abstract] 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 was<12 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.endprint