自制尿道导向器在尿道损伤中的应用

目的：探讨自制尿道导向器在尿道损伤中的应用方法和疗效。方法：对38例尿道损伤患者第一时间于床边应用自制尿道导向器，轻贴尿道12点处缓慢推进，到达损伤部位，如能顺利滑人并通过受损部位，则证实为尿道黏膜损伤或尿道不完全断裂伤。将尿道导向器推人膀胱，置人斑马导丝或输尿管导管至膀胱，顺导丝推人剪开尖部小孔的二腔或三腔气囊导尿管，完成操作。如置入尿道导向器受阻，考虑尿道完全性断裂，标志并记住受损位置，送手术室在硬膜外麻或局麻下行耻骨上膀胱穿刺，插入弯型尿道导向器至断端处，由尿道口置人直型尿道导向器，两导向器在断端处对接，或由尿道外口置入输尿管镜于尿道断端处，发现弯型尿道导向器头部中心孔并对接，置入导丝通过对接口至膀胱，顺导丝推入导尿管。结果：本组38例均一次操作手术成功，术后均恢复正常排尿。其中5例有不同程度尿道狭窄，经3～6个月尿道扩张，均能达到正常排尿。2例尿道狭窄较明显患者行尿道镜检查，尿道瘢痕长度均小于1．5cm。结论：自制尿道导向器在尿道损伤中应用效果良好，在尿道黏膜损伤、尿道裂伤、尿道不完全断裂伤中能在第一时间于床边给予有效处理治疗。在尿道完全性断裂伤中，手术快速简单，治疗效果良好，能有效减少尿道狭窄的发生或减少瘢痕长度。

The application of self-made urethral guide in urethral injury

Objective：To discussion the application of self-made urethral guide in urethral injury and its cura tive effect. Methods：38 cases of patients with urethral injury, using self made urethral guide for the first time in the bedside, slow progress along 12 points of urethral then reach the damaged parts, if you can smoothly slide into and through the damaged parts, are confirmed for the urethra mucous membrane damage or not completely broken in the urethra. Putting self-made urethral guide into the bladder, imbedding guidewire or ureteral catheter to the bladder, then push 2 or 3 cavity balloon catheter along with the guidewire and complete the operation. If it is hard to place self-made urethral guide, which considering urethral completeness fracture, sign and remember the dam aged location, then sent to the operating room taking punctio vesicae in the epidural anesthesia or local anesthesia, then insert bending urethra guide to the damaged location, and insert straight urethral guide from urethral orifice , then the guide at the cut ends butt. Also by placing ureteroscopy to find bending urethral guide and butt joint, pla- cing guidewire through the butt joint and push the catheter into the blaader along with the guidewire. Results： All 38 cases are success once-through operation and all back to normal urination, including 5 cases of urethral stric-ture, but all can achieve normal urination after 3-6 months urethral expansion. 2 severe cases with microscopic examination of the urinary tract and found urethral scar length are less than 1.5 cm. Conclusions：The in application effect of self-made urethral guide in urethral injury is good, which could give effective treatment processing near the bed in the first place on the patients with urethra mucous membrane injury, urethra laceration or urethra is not completely broken. Patients with urethra completeness fracture injury could have an operation quickly and easily by self-made urethral guide which also can effectively reduce the urethral stenosis occurred or reduce the length of scar.