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目的探讨带鞘膀胱镜在急诊治疗闭合性尿道球部损伤中的疗效。方法对57例闭合性尿道球部损伤病例急诊行带鞘膀胱镜下尿道会师术治疗,并对临床资料进行回顾性分析。结果 19例门诊治疗,住院治疗38例,平均手术时间15min(10～45min),平均住院天数6d(4～13d)。57例尿道损伤患者均能顺利留置尿管,术后4～8周拔除尿管。11例尿道完全断裂患者中,4例通过膀胱造瘘术以尿道探子加以指示后顺利置管。53例拔管后排尿通畅,常规定期尿道扩张1～3个月后最大尿流率18～25mL/s;3例发生尿道狭窄,定期尿道扩张3～6个月后最大尿流率16～23mL/s;1例拔管3个月后尿道严重狭窄,行冷刀内切开、尿道瘢痕汽化电切术治疗后排尿通畅。结论带鞘膀胱镜尿道会师术具有操作简便、损伤小、手术时间短、可门诊操作、有效恢复尿道连续性的优点,可用于闭合性尿道球部损伤的急诊治疗。
Objective To investigate the efficacy of sheath cystoscopy in the treatment of closed urethral bulb injury. Methods Fifty - seven cases of closed urethral injuries were treated by urethral mastectomy with sheath and cystoscope. The clinical data were retrospectively analyzed. Results Nineteen outpatients and 38 hospitalizations were performed. The average operation time was 15min (10 ~ 45min) and the average length of stay was 6d (4 ~ 13d). Fifty-seven cases of urethral injury were able to successfully catheterization, removal of the catheter 4 to 8 weeks after surgery. Among the 11 patients with complete rupture of the urethra, 4 were successfully catheterized by urethral probe after bladder ostomy. In 53 cases, the urination was smooth after extubation, and the maximal uroflow rate was 18-25mL / s in 1-3 months after conventional urethral dilatation. The maximal uroflow rate was 16-23mL in 3 cases with urethral stricture and regular urethral dilation 3-6 months / s; 1 case of severe urethral stricture after extubation 3 months, cold knife incision, urethral scar electrovaporization after treatment of urinary tract patency. Conclusions The urethra mastectomy with sheath and cystoscope has the advantages of simple operation, small injury, short operative time, outpatient operation and effective restoration of urethral continuity. It can be used in the emergency treatment of closed urethral bulb injury.