不同急诊处理方式对前尿道损伤后狭窄发生的影响

目的探讨前尿道损伤后不同急诊处理方式对远期发生尿道狭窄的影响。方法回顾性分析2003年1月—2012年1月前尿道损伤60例的临床和随访资料,根据损伤程度和急诊处理方式分组,比较远期尿道狭窄发生率。结果所有患者平均随访24(18~38)个月,狭窄发生时间为伤后1~13(4.6±2.4)个月。前尿道部分断裂患者38例,其中膀胱造瘘组狭窄发生率12.5%(2/16)低于留置导尿组50.0%(11/22),差异有统计学意义(P<0.05);完全断裂患者22例,其中膀胱造瘘组狭窄发生率66.7%(6/9)与留置导尿组84.6%(11/13)相比无统计学差异(P>0.05)。不考虑损伤程度时,膀胱造瘘组狭窄发生率32.0%(8/25)显著低于留置导尿组62.8%(22/35)(P<0.05)。结论对于前尿道损伤首选膀胱造瘘尿流改道可能减少远期尿道狭窄的发生。

Impact of different anterior urethra injury management on urethral stricture formation

Objective To explore the impact of different anterior urethra injury management on urethral stricture formation. Methods A retrospective study was performed on 60 patients who presented with anterior injury between January 2003 and January 2012. The clinical and follow-up data were reviewed and the incidence of urethral stricture was compared in terms of different injury degrees and immediate management approaches. Results According to the follow-up of 24 （ 18 -38 ） months, stricture formation occurred in 4.6 ±2.4 （ 1 - 13） months after injury. In the 38 patients with partial urethral stricture, the stricture formation occurred in 2 of 16 patients （ 12.5 % ） with suprapubic cystostomy and in 11 of 22 （50.0%） with urethral realignment over a urethral catheter （ P 〈 0.05 ）. In the 22 patients with complete urethral stricture, the stricture formation occurred in 6 of 9 patients （66.7%） with suprapubic eystostomy and in 11 of 13 （84.6%） with urethral realignment over a urethral catheter （P 〉0.05）. Strictures occurred in 8 of 25 （ 32.0% ） patients treated initially with suprapubie eystostomy and in 22 of 35 （62.8%） treated with primary urethral realignment （ P 〈 0.05 ） if not considering the degree of injury. Conclusion Suprapubie cystostomy as a primary treatment after anterior urethral injury is likely to reduce urethral stricture formation.