64例骨盆骨折合并后尿道损伤的早期治疗

目的探讨骨盆骨折合并后尿道损伤的安全、有效治疗方法。方法对64例后尿道损伤的早期治疗回顾性分析,单纯后尿道挫伤者行尿道插管16例,尿道部分破裂或完全断裂者行尿道会师牵引术或会师牵引加固定术28例,一期尿道吻合术12例,病情危重者仅行耻骨上膀胱造瘘8例。结果留置尿管16例,排尿通畅13例,排尿接近正常3例。22例(78.6%)行尿道会师术者得到治愈,10例(83.3%)行尿道吻合术者得到治愈,耻骨上膀胱造瘘者均形成尿道闭锁,阳痿12例。结论尿道损伤的预后与早期诊治是否恰当有关,在多脏器损伤合并尿道损伤中,条件许可者应行一期尿道吻合术,其疗效好,病程短;不适合一期吻合者,尿道会师加牵引术可作为首选方法,对病情危重者以耻骨上膀胱造瘘术为宜。

Early management of 64 cases of posterior urethral injury caused by traumatic pelvic fracture

Objective To investigate a safe and effective management for urethral injury complicating pelvic. Methods Retrospective analysis of 64 cases with posterior urethral injury was performed. 16 cases with simple contusion of posterior urethral posterior urethral were treated by catheterized.28 cases with partial repture or complete repture of posterior urethral were treated by realigment with traction.12 cases were treated by urethral anastomosis .8 cases with serious complications were treated only by suprapubic cystostomy. Results Amony the 16 cases with simple catheterization ,13 cases had normal urination ,3 cases needed several dilatation after the initial management.The sucess rate for realignment with traction was 78.6%(22 cases),while the sucess rate for urethral anastomosis was 83.3%(10cases).All the posterior urethral injuries treated by suprapubic cystostomy became urethral atresia at last. Impotence occurred at 3 cases. Conelusions The prognosis of the injury of posterior urethral is closely related with the success of the right early diagnosis and treatment.Selection of the appropriate management option depends on the cases condition,the extent of injury and the time of diagnosis.To posterior uretheral injury complicated by multiple organ injuries.If the cases condition dosa permit,the effect of early uretheral realigmnent is good.To the cases who are not suitable to early urethral anastonosis ,urethral realignment with traction is the first option.While suprapubic cystostomy is only suitable to the serious and risk cases.