骨盆骨折尿道损伤的即刻处理——内镜下会师复位还是膀胱造口术？

The Immediate Management of Pelvic Fracture Urethral Injury-Endoscopic Realignment or Cystostomy?

机构信息

Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.

出版信息

J Urol. 2017 Oct;198(4):869-874. doi: 10.1016/j.juro.2017.04.081. Epub 2017 Apr 23.

DOI:10.1016/j.juro.2017.04.081

PMID:28442385

Abstract

PURPOSE

We determined whether endoscopic realignment or cystostomy would provide the best immediate management of pelvic fracture urethral injury.

MATERIALS AND METHODS

We retrospectively reviewed the records of 590 patients with pelvic fracture urethral injury. Of the patients 522 were included in analysis due to strict criteria, including 129 in the endoscopic realignment group and 393 in the cystostomy group. Data on stricture formation and length, intervention technique and long-term functional outcomes were analyzed.

RESULTS

In the endoscopic realignment group stricture developed in 111 patients (83%) at a mean of 23.5 months, which is longer than the 7.6 months reported in the cystostomy group (p <0.05). Mean stricture length was 3.2 cm in the realignment group and 3.7 cm in the cystostomy group (p <0.05). Internal urethrotomy was performed in 21 patients (19%) treated with realignment vs 18 (5%) treated with cystostomy (p <0.05). Further repair was accomplished via simple perineal anastomosis in 57 patients (51%) with realignment and 138 (35%) with cystostomy (p <0.05). Ancillary procedures such as corporeal splitting, inferior pubectomy and crural rerouting were necessary in 14 (13%), 14 (13%) and 5 patients (4%) in the endoscopic realignment group, and in 94 (24%), 100 (25%) and 43 (11%), respectively, in the cystostomy group (all p <0.05). The rates of impotence and incontinence did not statistically differ between the endoscopy and cystostomy groups (14.3% vs 16.2% and 1.6% vs 2.1%, respectively, p >0.05).

CONCLUSIONS

Endoscopic realignment may reduce stricture formation and length, and facilitate urethroplasty. However, endoscopic realignment is also associated with a prolonged clinical course for recurrence.

摘要

目的

我们旨在确定内镜下尿道会师术还是膀胱造瘘术在骨盆骨折后尿道损伤的即刻处理中更具优势。

材料与方法

我们对 590 例骨盆骨折后尿道损伤患者的病历进行了回顾性分析。其中 522 例患者符合严格的纳入标准，包括内镜下尿道会师术组 129 例，膀胱造瘘术组 393 例。分析了两组患者的尿道狭窄形成情况和长度、干预技术及长期功能结局。

结果

内镜下尿道会师术组 111 例（83%）患者发生狭窄，平均时间为 23.5 个月，明显长于膀胱造瘘术组的 7.6 个月（p<0.05）。内镜下尿道会师术组的平均狭窄长度为 3.2cm，膀胱造瘘术组为 3.7cm（p<0.05）。内镜下尿道会师术组有 21 例（19%）患者行尿道内切开术，而膀胱造瘘术组仅 18 例（5%）患者行该术式（p<0.05）。进一步修复时，内镜下尿道会师术组有 57 例（51%）患者行单纯会阴部吻合术，而膀胱造瘘术组有 138 例（35%）患者行该术式（p<0.05）。14 例（13%）内镜下尿道会师术组患者需要行阴茎海绵体切开术、耻骨下切除术和耻骨弓下转位术，而膀胱造瘘术组患者中分别有 14 例（13%）、100 例（25%）和 43 例（11%）患者需要行上述术式（均 p<0.05）。内镜下尿道会师术组和膀胱造瘘术组患者的阳痿和尿失禁发生率分别为 14.3%和 16.2%、1.6%和 2.1%，差异均无统计学意义（均 p>0.05）。