女童陈旧骨盆骨折尿道外伤的治疗经验  

Experience in the treatment of urethral injuries due to old pelvic fractures in girls

作　　者：王冠男[1] 孙宁[1] 张潍平[1] 田军[1] 李明磊[1] 宋宏程[1] 林德富[1] Wang Guannan;Sun Ning;Zhang Weiping;Tian Jun;Li Minglei;Song Hongcheng;Lin Defu(Department of Surgical Urology,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《中华泌尿外科杂志》2023年第8期601-605,共5页Chinese Journal of Urology

摘　　要：目的探讨女童陈旧骨盆骨折尿道外伤的治疗方法。方法回顾性分析2015年4月至2023年4月北京儿童医院收治的10例陈旧骨盆骨折尿道外伤女童的临床资料。年龄(8.5±4.3)岁。7例合并尿道阴道瘘,1例合并膀胱阴道瘘;5例存在远端尿道闭锁或细小狭窄;5例合并阴道狭窄或部分闭锁。手术方式:经会阴尿道阴道瘘修补术1例,经耻骨尿道吻合术(端端吻合)2例,经耻骨尿道阴道瘘修补术+膀胱颈尿道吻合术1例,经耻骨尿道成形术(膀胱颈及尿道拖出)+尿道阴道瘘修补术+膀胱颈重建术4例,经耻骨尿道成形术+膀胱颈重建术1例,肠扩大膀胱阑尾代输出道可控性尿流改道术1例。术后观察排尿情况。每日使用尿垫数量>1片为尿失禁,≤1片为控尿良好;主诉排尿费力,最大尿流率<10ml/s为排尿困难。结果本研究10例手术均顺利完成,术后无伤口感染、组织坏死等并发症。术后随访时间(52.0±26.2)个月。2例术后控尿良好,无排尿困难;7例出现并发症,其中2例因尿道狭窄致排尿困难,行尿道扩张后好转;5例尿道阴道瘘复发,其中3例再次行修补手术,再次手术后2例控尿良好,无排尿困难。1例尿流改道患者术后恢复良好。结论女童陈旧骨盆骨折尿道外伤的处理较复杂,术后并发症发生率高,需根据年龄、病变严重程度和尿道、阴道条件选择合适的处理方式。Objective To discuss the treatment methods for old pelvic fractures and urethral injuries in young girls.Methods We retrospectively analyzed the clinical data of 10 girls,mean age of(8.5±4.3)years with old pelvic fractures and urethral injuries treated with different surgical methods in our hospital from April 2015 to April 2023.7 cases were complicated with urethrovaginal fistula,1 case was complicated with vesicovaginal fistula;5 patients had distal urethral atresia or stenosis;5 cases complicated with vaginal stenosis or partial atresia.One case underwent repair of urethrovaginal fistula via transpertoineal approach,two cases underwent urethral anastomosis(end to end anastomosis)via transpubic approach,one case underwent repair of urethrovaginal fistula and bladder neck urethral anastomosis via transpubic approach,four cases underwent urethroplasty repair of urethrovaginal fistula and bladder neck reconstruction surgery,one underwent urethroplasty and bladder neck reconstruction surgery via transpubic approach,one underwent augmented enterocystoplasty and continent urinary diversion by using the appendix.Observe the urination condition after operation(Urinary incontinence is defined as the use of more than 1 piece of urine pad per day,good urination is defined as the use of≤1 piece of urine pad per day,and dysuria is defined as the complaint of laborious urination,and the maximum urine flow rate is less than 10 ml/s).Results All surgeries were successfully completed without complications such as wound infection or tissue necrosis.The postoperative follow-up time was(52.0±26.2)months.2 cases achieved good continence and no dysuria.Postoperative complications occurred in 7 cases,of which 2 cases had dysuria due to urethral stricture and improved after urethral dilatation;5 cases of urethrovaginal fistula recurred,of which 3 cases had undergone rerepair surgery,and 2 of them achieved good urinary control without dysuria.One case with enterocystoplasty and contiunent urinary diversion recovered well after surg

关 键 词：陈旧骨盆骨折 尿道外伤 女童 

分 类 号：R726.8[医药卫生—儿科]