软性和硬性输尿管镜联合应用治疗尿道损伤16例报告  

Combining Flexible Ureteroscopy and Rigid Ureteroscopy for Ureteral Injury: Report of 16 Cases

作　　者：杨四文 孙菊元 田维云 贾其磊[1] 林思进 殷波[1] 

机构地区：[1]四川省攀枝花市第二人民医院泌尿外科,攀枝花617068

出　　处：《中国微创外科杂志》2012年第11期1037-1039,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨联合应用软性和硬性输尿管镜治疗尿道损伤的疗效。方法 2003年6月～2011年12月我院联合应用软性和硬性输尿管镜对16例尿道损伤实施腔内尿道会师术。耻骨上膀胱穿刺造瘘,沿造瘘管置入F7.5软性输尿管镜,通过尿道内口达到尿道近断端。助手从尿道外口置入Wolf F8.0/9.8硬性输尿管镜,达到尿道远断端可见到软性输尿管镜头或亮光,从硬镜操作孔置入导丝,用软性抓钳将导丝钳入膀胱,撤出硬镜,沿导丝置入F18三腔气囊硅胶尿管,并经软性输尿管镜证实进入膀胱,气囊注水20 ml,留置膀胱造瘘。结果 7例球部尿道完全断裂,均会师成功;9例膜部尿道断裂,7例成功,2例失败。16例随访5～48个月,平均21个月,12例排尿正常,2例膜部损伤出现尿道狭窄,经尿道等离子电切后治愈,中转为开放手术的2例,术后常规定期尿道扩张,排尿正常,未出现尿道狭窄等并发症;3例有勃起功能障碍。结论双镜联合应用下行腔内尿道会师术,具有损伤小,并发症少,恢复快,手术操作简单,是治疗尿道损伤安全有效的方法。Objective To explore the efficacy of flexible combined with rigid ureteroscope for urethral injury. Methods Since June 2003 to December 2011, we performed urethral realignment on 16 patients with urethral injury by using flexible ureteroscopy combined with rigid ureteroscopy. By suprapubie bladder puncturing, via the internal urethral orifice, we placed a F7.5 flexible ureteroscope close to the urethral stump; and then via the external urethral orifice, we inserted a Wolf F8.0/9.8 rigid ureteroscope to reach the urethral stump. Through the rigid ureteroscope, we introduced a wire into the bladder, and then a F18 three-cavity balloon catheter （confirmed by flexible ureteroscopy） to infuse 20 ml water. Results In the 16 patients, complete bulbar urethral disruption was confirmed in 7 cases and all of them were cured ; membranous urethral disruption was diagnosed in the other 9, and 2 of them were failed in the procedure. The patients were followed up for 5 to 48 months with a mean of 21 months, 12 of them showed normal urination, and 2, who had membranous urethral disruption, developed urethral stricture, and then were cured by transurethral plasmaknefic resection. Two patients were converted to open surgery during the procedure, thus they received regular urinary dilation after the operation, and showed normal urination without urethral stricture. Three patients developed erection dysfunction after the therapy. Conclusion Flexible combined with rigid ureteroscope for urethral realignment is effective, simple, safe, and minimally invasive for urethral injury with a low rate of complications and quick recovery.

关 键 词：输尿管镜 尿道会师术 尿道损伤 

分 类 号：R699.6[医药卫生—泌尿科学]