骨盆骨折致后尿道损伤的早期处理

目的探讨骨盆骨折致后尿道损伤的早期处理方案。方法分析33例骨盆骨折致后尿道损伤病例的临床资料，在病情允许的情况下，急诊行尿道端端吻合术及膀胱造瘘术或尿道会师牵引固定术；若病情危重，仅行单纯膀胱造瘘术。结果31例患者经过1～7年随访，平均3．3年，尿道损伤早期治愈21例，并发尿道狭窄8例，尿失禁2例，阳痿6例。1例死于难以控制的大出血，1例死于晚期深部难以控制的感染。结论早期尿道端端吻合术及膀胱造瘘术治愈率高，尿道狭窄发生率较低，但阳痿发生率较高；尿道会师牵引固定术后多引起瘢痕性尿道狭窄，但缩小了尿道断端对合不良和错位距离，减小延期手术难度，为后期进行微创手术创造了有利条件；单纯膀胱造瘘术后必然遗留尿道狭窄，仅适用于病情危重的患者。

Emergency treatment of pelvis fracture complicated with urethral injury

Objective To investigate emergency treatment of urethral injury caused by pelvic fracture. Methods 33 eases with urethral injury and pelvic fracture were retrospectively analyzed. If the patient＇s condition was permitted, the patients were treated with urethral realignment with traction or urethral anastomosis and suprapubic eystostomy. Patients with serious complications were treated only by suprapubic cystostomy. Results 21 eases with urethral injury were early cured. The complications were including urethral stricture （8 eases）, urinary incontinence （2 eases） and sexual impotence （6 eases）. 1 ease died of huge hemorrhea and 1 case died of infection. Conclusion The methods of treatment of pelvis fracture complicated with urethral injury depend on the condition of the patients, the extent of injury and the time of diagnosis.