膀胱软镜尿道会师术急诊治疗骨盆骨折尿道断裂的临床效果  

Outcome of early endoscopic realignment with flexible cystoscope for pelvic fracture urethral injury

作　　者：王建伟 类福炜 徐啸 刘振华 鲍正清 夏海缀 王杰 李贵忠 黄广林 Wang Jianwei;Lei Fuwei;Xu Xiao;Liu Zhenhua;Bao Zhengqing;Xia Haizhui;Wang Jie;Li Guizhong;Huang Guanglin(Department of Urology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Department of Urology,the People's Hospital of Lanling County,Lanling 277700,China)

机构地区：[1]首都医科大学附属北京积水潭医院泌尿外科,北京100035 [2]兰陵县人民医院泌尿外科,山东兰陵277700

出　　处：《中华泌尿外科杂志》2023年第8期591-595,共5页Chinese Journal of Urology

基　　金：北京市属医院科研培育计划项目(PX20211017)。

摘　　要：目的探讨膀胱软镜尿道会师术急诊治疗骨盆骨折尿道断裂的临床效果。方法回顾性分析2018年3月至2022年6月北京积水潭医院急诊收治的60例骨盆骨折尿道断裂患者的临床资料。患者均为男性。急诊治疗行膀胱软镜尿道会师术(会师组)33例,膀胱造瘘(造瘘组)27例。会师组和造瘘组的年龄分别为(42.2±13.8)岁和(44.1±15.0)岁,差异无统计学意义(P=0.605)。会师组致伤原因为车祸伤20例(60.6%),高处坠落伤11例(33.3%),挤压伤2例(6.1%);造瘘组致伤原因为车祸伤15例(55.6%),高处坠落伤12例(44.4%),两组间差异无统计学意义(P=0.336)。两组均于B超引导下行膀胱造瘘。膀胱造瘘后,会师组顺行置入膀胱软镜,经膀胱颈口至后尿道断裂处近端置人输尿管支架管。由尿道外口逆行进镜寻找输尿管支架管,用异物钳夹持并拉出尿道外口。沿输尿管支架管置入斑马导丝,沿斑马导丝置入F16硅胶尿管。比较两组术后尿道狭窄情况和处理方法,以及后尿道吻合成形术的复杂程度。后尿道吻合成形术中仅行单纯吻合切除的定义为简单后尿道吻合成形术,需采用阴茎海绵体纵隔劈开、耻骨部分切除等辅助技术的定义为复杂后尿道吻合成形术。结果会师组手术时间为(24.5±7.0)min,无术中并发症;术后尿道出血4例(12.1%),泌尿系感染发热2例(6.1%),对症处理保守治疗后均好转。会师组术后发生尿道狭窄28例(84.8%),狭窄段长度(3.10±1.20)cm;造瘘组术后发生尿道狭窄27例(100.0%),狭窄段长度(3.83±1.18)cm,两组的尿道狭窄长度差异有统计学意义(P=0.026)。会师组接受后尿道吻合成形术24例(85.7%),其中简单后尿道吻合成形术8例(33.3%),复杂后尿道吻合成形术16例(66.7%);内镜下切开和扩张各2例(7.1%)。造瘘组接受后尿道吻合成形术25例(92.6%),其中简单后尿道吻合成形术6例(24.0%),复杂后尿道吻合成形术19例(76.0%);内镜下切开2例(7.4%)。两组Objective To explore the clinical outcome of early endoscopic realignment with flexible cystoscope for pelvic fracture urethral injury.Methods We retrospectively collected and analyzed the clinical data of patients with pelvic fracture urethral injuries in ER of Beijing Jishuitan Hospital from March 2018 to June 2022.Seventy-six male patients with PFUI were reviewed and 60 patients were included due to the integrity of data collected.The patients were divided into early endoscopic realignment(EER)group and suprapubic cystostomy(SC)group according to the acute management.There were 33 patients and 27 patients in EER group and SC group,respectively.The age of the patients were(42.2±13.8)years and(44.1±15.0)years in EER group and SC group,respectively.The causes of the injuries were car accident,falling and crush,the percentage of the patients were 60.6%(20 cases),33.3%(11 cases),6.1%(2 cases)and 55.6%(15 cases),44.4%(12 cases),0 in EER group and SC group,respectively.The difference between two groups was statistically insignificant.The procedure of EER began with a cystostomy guided by B ultrasound,then an antegrade cystoscopy was performed through the cystostomy while negociating the bladder neck to the proximal side of injured urethra.A ureteral stent was inserted into the broken urethra and retrieved by a forceps through retrograde urethroscopy with another flexible cystoscope.We inserted a guidewire into the ureteral stent before removing it and placed a 16F urethral catheter along the guidewire.We analyzed the difference between two groups including the incidence,the length and the management of urethral stricture and the complexity of urethroplasty if needed.The simple urethroplasty was defined as performing anastomosis after dissection of the bulbar urethral and removing the scar tissue,while the procedure was defined as complex urethroplasty if ancillary procedures,such as separating the corporal bodies and partial pubectomy,was needed.Results The EER group and SC group had 33 patients and 27 patients,res

关 键 词：尿道 损伤 骨盆骨折 车软镜会师 

分 类 号：R683.3[医药卫生—骨科学]