摘要
目的 总结男童外伤性后尿道狭窄的诊治经验。 方法 陈旧性后尿道外伤患儿 2 10例。其中经尿道内切开 (TUR) 112例 ,经耻、会阴联合修复尿道 4 4例 ,经会阴修复尿道 32例 ,会阴尿道造瘘及两尿道断端间插入带蒂阴囊皮管做吻合 2 0例 ,可控性尿流改道 (Mitrofanoff术 ) 1例 ,经直肠会阴修复尿道 1例。 结果 2 10例随访 6个月～ 14年 ,获正常排尿 187例 (89% ) ,有不全尿失禁 17例 ,会阴尿道造瘘尚未修复 5例 ,需清洁间歇导尿 1例。 结论 后尿道外伤的急症处理非常重要 ,单纯膀胱造瘘仅用于不全性尿道断裂。经尿道内切开适用于绝大多数单纯性后尿道狭窄 ,经耻、会阴联合修复尿道适用于复杂性后尿道狭窄或 (和 )闭锁段 >2cm者。
Objective To present experience on the management of traumatic posterior urethral stricture or obliteration in boys. Methods Treatment included transurethral resection (TUR) in 112 cases,combined perineal-transpubic urethral repair in 44,via perineal approach for urethral repair in 32,perineal urethrostomy performed either transpubicaly or(and) via perineal approach or interposition of a segment of pediculated skin tube of scrotum in 20 cases,Mitrofanoff in one,urethra anastomotic repair through rectal and perineal approach in one. Results The whole series have been followed up for 6 months to 14 years.Normal urination was achieved in 187(89%),incomplete urinary incontinence in 17,still with perineal urethrostomy in 5,and intermittent catheterization needed in 1.Posterior urethral diverticulum with chronic epididymitis persisted in one. Conclusions Appropriate initial treatment is important for the management of traumatic posterior urethral injury.In fresh cases simple cystostomy was only carried out for incomplete urethral disruption,end to end anastomosis via suprapubic combined with perineal approach is indicated in complete urethral disruption.For old urethral injury,internal urethrotomy is good for the majority of simple stricture.Transpubic combined with perineal approach is indicated for the length of posterior urethral stricture or obliteration longer than 2 cm.If the proximal urethral end is long enough for exposure the urethra can be repaired via perineal approach alone. Perineal urethrostomy should be reserved for patients with long segment of urethral obliteration.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2003年第8期558-560,共3页
Chinese Journal of Urology
