Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan.
Department of Urology, Nishisaitama-chuo National Hospital, Tokorozawa, Saitama, Japan.
Int J Urol. 2020 Nov;27(11):1002-1007. doi: 10.1111/iju.14344. Epub 2020 Aug 9.
Pubectomy is an ancillary technique used to increase exposure of the disrupted urethra and reduce anastomotic tension, which can be difficult for inexperienced surgeons. The objective of the present study was to illustrate the use of an air drill enabling delicate and precise bone resection in pubectomy for delayed anastomotic urethroplasty for pelvic fracture urethral injury.
Between 2009 and 2019, 88 male patients underwent delayed anastomotic urethroplasty with pubectomy for pelvic fracture urethral injury. A total of 73 procedures used a high-speed surgical air drill (HiLAN HS; Aesculap, Tuttlingen, Germany) equipped with a short-hand piece. Operative time and blood loss in the air drill patient group (group 1) were compared with that of patients who underwent pubectomy using a rongeur and/or gouge (group 2, n = 15).
In 65 group 1 patients, urethroplasty was carried out using the perineal approach, with partial inferior pubectomy. Eight group 1 patients, whose proximal urethral end was displaced upward superior to the upper edge of pubis, underwent urethroplasty using the perineal and abdominal approach, with a superior partial pubectomy and supracrural urethral rerouting. No difficulty was encountered using the air drill in any of the cases. There was no significant difference in median operative time between the groups (group 1 256 min vs group 2 228 min; P = 0.31). The median blood loss in group 1 was significantly lower than group 2 (149 mL vs 453 mL; P < 0.0001).
Surgical air drills might facilitate pubectomy in patients undergoing delayed anastomotic urethroplasty for pelvic fracture urethral injury. This tool offers the advantage of a delicate bone resection with reduced blood loss.
耻骨切除术是一种辅助技术，用于增加破裂尿道的显露度并降低吻合口张力，这对于经验不足的外科医生来说可能具有挑战性。本研究的目的是展示在骨盆骨折尿道损伤后延迟吻合尿道成形术中使用空气钻进行耻骨切除的应用，以实现精细和精确的骨切除。
2009 年至 2019 年间，88 名男性患者因骨盆骨折尿道损伤接受了延迟吻合尿道成形术和耻骨切除术。共有 73 例手术使用高速手术空气钻（HiLAN HS；Aesculap，德国图特林根），配备短手柄。比较空气钻组（第 1 组）和使用咬骨钳和/或骨凿的耻骨切除术组（第 2 组，n=15）的手术时间和失血量。
在 65 例第 1 组患者中，经会阴入路行尿道成形术，行部分耻骨下切除。8 例第 1 组患者近端尿道末端向上向上移位至耻骨上缘以上，行会阴和腹部入路，行耻骨上部分切除和耻骨上尿道再通。在任何情况下，空气钻的使用都没有遇到困难。两组的中位手术时间无显著差异（第 1 组 256 分钟比第 2 组 228 分钟；P=0.31）。第 1 组的中位失血量明显低于第 2 组（149 毫升比 453 毫升；P<0.0001）。
在骨盆骨折尿道损伤后行延迟吻合尿道成形术的患者中，手术空气钻可能有助于耻骨切除术。该工具具有精细骨切除和减少失血量的优势。
