输尿管镜、尿道镜下腔内尿道会师术治疗尿道损伤28例

目的探讨输尿管镜、尿道镜下腔内尿道会师术治疗尿道损伤的疗效。方法 2006年1月～2011年1月采用输尿管镜、尿道镜下尿道会师术治疗尿道损伤28例,经尿道输尿管镜探查明确损伤部位,对损伤较轻者,输尿管镜探查后直接进入膀胱,在输尿管支架管引导下置入F18～F20完成尿道会师;对输尿管完全断裂者,输尿管镜明确后行膀胱造瘘,在尿道镜引导下行输尿管支架管引导从尿道外口置入F18～F20尿管完成尿道会师,术后对尿道狭窄者定期尿道扩张。结果 28例均一次性成功,手术时间5～36 min,平均16 min。术中见尿道黏膜挫伤4例、球部尿道后壁穿孔4例、后尿道黏膜撕裂伤4例、尿道部分撕裂伤10例、尿道完全断裂伤6例,4例合并前列腺增生。23例随访3～36个月,平均27个月,其中20例随访〉24个月：术后均恢复正常排尿,最大尿液率17～22 ml/s,平均20 ml/s;9例尿道狭窄分别行冷刀内切开（3例）和直视下尿道扩张（6例）。结论经尿道腔镜下会师术操作简单,患者痛苦小,尿道排尿功能恢复良好。

Endoscopic Urethral Realignment for Urinary Injury:Report of 28 Cases

Objective To discuss the efficacy of endoscopic urethral realignment for urinary injury.Methods Since January 2006 to January 2011,28 patients with urinary injury received endoscopic urethral realignment in our hospital.The position of the injury was determined with endoscopy,and then,after urethral exploration,urethral realignment was performed under the guidance of a ureteral stent by transurethral ureteroscopy with a F18-F20 catheter.For patients with completely ruptured ureter,cystostomy was carried out before the realignment.Urinary dilation was made regularly after the procedure in patients with urinary stricture.Reuslts The procedures were succesffuly completed in one session in all the 28 patients within a mean of 16 minutes(ranged from 5 to 36 minutes).Among the patients,urethral mucosal laceration was detected in 4 cases,posterior wall of the bulbar urethra perforation in 4 cases,posterior urethral mucosal tearing in 4 cases,urethral part tearing in 10 cases,and urethral completely frature tear in 6 cases.The patients were followed up for 3 to 36 months with a mean of 27 months(>24 months in 20 of the cases),during which all the patients recovered normal urination with a maximum flow rate(Qmax) of 17-22 ml/s(mean,20 ml/s).Urinary stricture was found in 9 patients postoperation,3 of them received cold knife urethrotomy,and the other 6 underwent urinary dilation.Conclusion We believe that endoscopic urethral realignment is a simple procedure,which is better tolerated by patients with good recovery of urinary function.