CAJ | 학술논문

目的：探讨输尿管镜技术在男性尿道损伤临床诊断和治疗中的应用。方法回顾性分析2002年1月～2011年12月收治的65例男性尿道损伤患者的临床资料，分析损伤部位、创伤原因、严重程度、手术方法、治疗效果和随访情况。其中29例接受耻骨上膀胱造瘘＋Ⅱ期尿道重建术（A组），36例接受输尿管镜辅助操作（B组）。结果A组前尿道损伤19例（破裂15例，断裂4例），后尿道损伤10例（破裂4例，断裂6例）。 B组前尿道损伤28例（破裂24例，断裂4例），后尿道损伤8例（破裂3例，断裂5例）。 B组手术时间（17±11） min，明显短于A组（65±17） min，术后近期尿道狭窄发生率（11.1％）也低于A组（31.0％）。两组在术中出血量和最大尿流率方面无统计学差异。结论使用输尿管镜判断男性尿道损伤的部位和程度可靠、微创，尤其适用于合并骨盆骨折的患者。与传统的早期膀胱造瘘＋Ⅱ期尿道重建手术相比，输尿管镜辅助手术操作方便、时间短，能在直视下恢复尿道连续性、引流尿液，并能避免二次手术。
목적：탐토수뇨관경기술재남성뇨도손상림상진단화치료중적응용。방법회고성분석2002년1월～2011년12월수치적65례남성뇨도손상환자적림상자료，분석손상부위、창상원인、엄중정도、수술방법、치료효과화수방정황。기중29례접수치골상방광조루＋Ⅱ기뇨도중건술（A조），36례접수수뇨관경보조조작（B조）。결과A조전뇨도손상19례（파렬15례，단렬4례），후뇨도손상10례（파렬4례，단렬6례）。 B조전뇨도손상28례（파렬24례，단렬4례），후뇨도손상8례（파렬3례，단렬5례）。 B조수술시간（17±11） min，명현단우A조（65±17） min，술후근기뇨도협착발생솔（11.1％）야저우A조（31.0％）。량조재술중출혈량화최대뇨류솔방면무통계학차이。결론사용수뇨관경판단남성뇨도손상적부위화정도가고、미창，우기괄용우합병골분골절적환자。여전통적조기방광조루＋Ⅱ기뇨도중건수술상비，수뇨관경보조수술조작방편、시간단，능재직시하회복뇨도련속성、인류뇨액，병능피면이차수술。
Objective To investigate the application of ureteroscope in the diagnosis and treatment of male urethral injury.Methods A retrospective analysis was performed in 65 males with urethral injury from Jan.2002 to Dec.2011.The type of injury,causes of trauma,severity,surgical methods,treatment and follow-up were re-viewed.Patients were divided into 2 groups according to the surgical method .Early supraubic cystostomy with de-layed urethroplasty was performed in 29 cases(Group A),while ureteroscopic-assisted catheterization or realignment was performed in 36 patients (Group B).Results In Group A,anterior urethral injury was demonstrated in 19 ca-ses (including 15 cases of urethral rupture and 4 cases of disruption),while posterior urethral injury was diagnosed in 10 cases (4 cases of rupture and 6 cases of disruption).In Group B,anterior urethral injury was demonstrated in 28 cases (including 24 cases of rupture and 4 cases of disruption),while posterior urethral injury was diagnosed in 8 cases (3 cases of rupture and 5 cases of disruption).The operative time in Group B was (17 ±11) minutes, which was significantly shorter than that in Group A (65 ±17)minutes.The formation of urethral stricture in Group B was significantly lower than that in Group A (11.1%vs.31.0%).But no statistical significance was observed in intra-operative blood loss and urinary peak flow rate between the two groups .Conclusion Ureteroscopic tech-nique is reliable and safe in the diagnosis and treatment of male urethral injury ,especially in patients combined with pelvic fracture.Ureteroscopic-assisted catheter placement and dual -endoscopic urethral realignment are easy to op-erate, and can restore the continuity of urethra in a short time under direct vision .