Mianné D, Pons F, Jancovici R, Thouard H, Guillotreau J, Dumurgier C
Hôpital d'instruction des Armées Laveran (Marseille).
Chirurgie. 1997;122(3):212-5.
Perineo-genital wounds involving the anterior perineum or the urogenital perineum are uncommon; 1-4% of all war wounds. We report 18 cases observed in war situations. Isolated uretrogenital wounds are rarely life-threatening, but the functional prognosis is always compromised in these men whose mean age is under 30 years. Debridements should be limited and all isolated lesions should be repaired early with tight suture of the cavernous body albuginea, preservation of viable testicular and adnexal tissue (but the rate of orchidectomy is greater than 50%), and immediate suture of any wound to the urethra rather than simple alignment. In war situations, these wounds are usually caused by perforating or blast trauma. The wounds are complex, with damage to the soft tissues, sometimes involving lesions to the anal sphincter, the gluteal masses or the abdomino-pelvic structures. Laparostomy for hemostasis is justified. The risk of sepsis is high, requiring triple antibiotics, cystostomy, careful debridement, discharge drainage or possibly colostomy. Treatment of urogenital lesions is a secondary operation in these cases but must not be neglected if the mictional and sexual functions are to be preserved.
累及会阴前部或泌尿生殖会阴的会阴 - 生殖器伤口并不常见，占所有战伤的1% - 4%。我们报告了在战争情况下观察到的18例病例。孤立的泌尿生殖伤口很少危及生命，但对于这些平均年龄在30岁以下的男性，其功能预后总是受到影响。清创应有限度，所有孤立的损伤应尽早修复，海绵体白膜进行紧密缝合，保留有活力的睾丸和附属组织（但睾丸切除术的发生率超过50%），对任何尿道伤口立即进行缝合而不是简单对合。在战争情况下，这些伤口通常由贯通伤或爆炸伤引起。伤口复杂，软组织受损，有时累及肛门括约肌、臀肌或腹盆腔结构。为止血而行剖腹造口术是合理的。败血症风险高，需要三联抗生素治疗、膀胱造口术、仔细清创、引流或可能需要结肠造口术。在这些病例中，泌尿生殖损伤的治疗是二期手术，但如果要保留排尿和性功能则绝不能忽视。
