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目的:探讨带外鞘引流腔镜下尿道会师术治疗尿道断裂的临床效果。方法:带外鞘引流腔镜下尿道会师术是以Peelaway鞘为外鞘,以肾镜或李逊镜作为观察镜,外接生理盐水冲洗进行尿道会师的手术方法。利用该技术共治疗前、后尿道断裂患者21例,并对治疗效果进行分析。结果:21例尿道断裂患者应用该方法进行尿道会师手术,成功20例,1例因尿道离断较长中转开放手术,术中均无明显冲洗液外渗。腔镜尿道会师成功20例患者中,前尿道断裂14例,手术时间(5.1±1.6)min,留置导尿管时间(26.0±5.1)d,尿道狭窄发生率57.1%,1例后期行尿道狭窄内切开治愈,余7例单纯行尿道扩张治愈,术后1年最大尿流率(18.8±1.8)ml/s;后尿道断裂6例,手术时间(15.8±7.5)min,留置导尿管时间均为8周,术后均继发不同程度尿道狭窄,均常规行尿道扩张,3例扩张后治愈,1例行经尿道狭窄内切开术治愈,2例后期行后尿道狭窄切除吻合术治愈。未再行开放手术的4例患者术后1年最大尿流率(17.9±1.9)ml/s。结论:带外鞘引流的腔镜下尿道会师术可以保持手术视野清晰,减少冲洗液外渗,缩短手术时间,提高手术成功率,治疗前、后尿道断裂术后早期临床效果满意。
Objective: To investigate the clinical results of treating the urethral rupture with external urethral catheterization and endoscopic urethral surgery. METHODS: Laryngeal urethral debridement with sheath drainage was performed with the Peelaway sheath as the sheath and the nephroscope or the Lysonoscope as the scope with an external saline flush for surgical intervention of the urethra. The technique was used to treat 21 cases of anterior and posterior urethral rupture, and the treatment effect was analyzed. Results: Twenty cases of urethral rupture were treated by urethral mastectomy. Twenty cases were successfully treated and one case was treated by long-term urethral interruption. There was no significant extravasation of irrigating fluid in operation. Among the 20 patients with successful endoscopic urethral catheterization, 14 cases had anterior urethral rupture, the operation time was (5.1 ± 1.6) min, catheterization time was (26.0 ± 5.1) days, the incidence of urethral stricture was 57.1%. One case was urethral stricture The incision was cured by incision. The other 7 cases were cured by urethral dilatation alone. The maximal uroflow rate (18.8 ± 1.8) ml / s at 1 year after operation, 6 cases of posterior urethral rupture, 15.8 ± 7.5 minutes of operation, indwelling catheter All the patients were followed up for different degrees of urethral stricture. All patients underwent urethral dilatation routinely. Three cases were cured after dilation. One case was cured by transurethral stricture incision and the other two cases were treated by posterior urethral stricture resection and anastomosis cure. The maximal urinary flow rate (17.9 ± 1.9) ml / s at 1 year after operation in 4 patients who did not undergo further open surgery. CONCLUSION: The endoscopic urethral mastectomy with sheath drainage can keep the operative field clear, reduce the extravasation of irrigating fluid, shorten the operation time and improve the success rate of operation. The clinical effect of early urethral rupture before and after the treatment is satisfactory.