骨盆骨折后尿道损伤早期复位缩短后期尿道狭窄长度  

Primary realignment of posterior urethral injury associated with pelvic fracture decreases the length of the ensuing urethral stricture

作　　者：饶明煌 孙星慧[1] 徐廷昭[1] 佟智超 朱长炎 陈兵华[1] 谭建明[1] 

机构地区：[1]厦门大学附属东方医院泌尿外科,350025

出　　处：《中华创伤杂志》2014年第11期1144-1147,共4页Chinese Journal of Trauma

摘　　要：目的 探讨骨盆骨折后尿道损伤的早期复位对后期尿道狭窄长度及尿道成形术的影响.方法 回顾性分析2008年1月-2012年1月收治64例合并骨盆骨折后尿道损伤患者的临床资料,其中34例早期行尿道复位（早期复位组）,30例早期行耻骨上膀胱造瘘术（造瘘组）和延期行尿道成形术恢复尿道完整性.评估和比较两组患者后期尿道狭窄发生率、尿道狭窄长度、延期尿道成形术及操作次数等指标.结果 早期复位组和造瘘组尿道狭窄发生率分别为53％（18/34）、100％（30/30）,均需延期行尿道成形术.早期复位组和造瘘组狭窄/闭锁长度分别为（1.8±0.6） cm、（2.9±0.7） cm（t=6.7,P＜0.05）.早期复位组发生狭窄的患者中,83％（15/18）行冷刀内切开术得到治愈,17％（3/18）需开放手术治疗;造瘘组只有60％ （18/30）的患者可通过冷刀内切开术得到治愈.早期复位组需行（1.6±0.6）次操作获得治愈,造瘘组需行（2.8±0.5）次操作获得治愈（t=9.2,P＜0.05）.结论 骨盆骨折后尿道损伤的早期复位有助于降低后期尿道狭窄的发生率及缩短狭窄长度,并降低延期尿道成形的手术难度及减少操作次数.Objective To determine the effect of primary realignment of posterior urethral injury associated with pelvic fracture on length and delayed operative treatment of ensuing urethral stricture.Methods A retrospective review was made on the clinical data of 64 patients with posterior urethral injury after pelvic fracture treated from January 2008 to January 2012.Of those patients,43 underwent primary endoscopic realignment （early realignment group） and 30 received primary suprapubic cystostomy （cystostomy group）.All were evaluated postoperatively for the late stricture rate,stricture length,types of delayed repair,and operation frequency.Results Rate of stricture was 53% （18/34） in early realignment group and 100% （30/30） in cystostomy group,but all were corrected by delayed urethroplasty.Mean length of the stricture was （1.8±0.6） cm in early realignment group and （2.9±0.7）cm in cystostomy group（t=6.7,P〈0.05）.Of the urethrostenosis patients in early realignment group,83% （15/18） were successfully corrected with a simple endoscopic cold incision and 17% （3/18） with open surgery.In contrast,only 60% （18/30） in cystostomy group were successfully corrected by endoscopic cold incision.Patients in cystostomy group underwent （2.8 ± 0.5） procedures for cure compared with （1.6 ± 0.6） procedures in early realignment group （t =9.2,P〈0.05）.Conclusion Primary endoscopic realignment for posterior urethral injury pelvic fracture offers the decrease in stricture incidence,stricture length,operation difficulty and operation frequency.

关 键 词：骨盆 骨折 尿道狭窄 

分 类 号：R699[医药卫生—泌尿科学]