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小儿闭合性尿道损伤的早期诊断和治疗 |
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曾祥辉 邱为民 章学理
摘要 目的：总结小儿闭合性尿道损伤的早期诊治经验。方法：回顾性分析26例本病患儿的临床资料。结果：前尿道损伤16例，球部损伤占9例，后尿道损伤10例。尿道挫伤13例，作保留导尿管+抗炎治疗；部分断裂4例，作膀胱单纯造瘘；完全断裂9例，作尿道会师+牵引。术后效果满意，并发症少。结论：对小儿闭合性尿道损伤，早期明确诊断，根据损伤程度和部位选择合理治疗方法，可取得较好效果。
关键词 尿道损伤 血尿 儿童
Early diagnosis and treatment of closed urethral
injury in the infant
Zeng Xianghui Qi Weming Zhang Xueli
(Department of Urology,The People′s Hospital of Chibi City,Hubei,437300)
Abstract Purpose:To summarize the experience of early diagnosis and treatment of closed urethral injuries in infants.Methods:Clinical data of 26 cases of urethral injuries in infants were analysed retrospectively.Results:16 cases were anterior urethral injures,9 bulbous urethral injury,and 10 posterior urethral injuries. Indwelling catheterization and anti-inflammation were performed in 13 cases of urethral contusion. Suprapubic cystostomy were executed in 4 cases of incomplete rupture of urethra.Urethra realignment plus traction were carried out in 9 cases of complete rupture of urethra.The postoperative effects were satisfactory with less complication.Conclusions:Early definite diagnosis and rational therapies in accordance with degree and position of urethral injury may obtain a favourable effect on closed urethral injury in the infant.
Key words Urethra injuries Hematuria Infant
对小儿闭合性尿道损伤，早期明确诊断，根据损伤程度和部位，及时治疗，可取得较好效果。
1 资料与方法
1.1 临床资料
26例患儿，男24例，女2例；年龄4～13岁，其中4～10岁14例，11～13岁12例。损伤原因：骑跨伤12例，会阴部其他暴力伤4例，车祸伤10例。损伤部位：前尿道损伤16例，球部损伤9例，后尿道损伤10例。
全部病例均有肉眼血尿；仅尿道口滴血，但无排尿困难13例；有排尿困难，会阴部青紫4例；合并骨盆骨折9例，其中并发直肠损伤及阴道损伤各1例。10例发生失血性休克。经膀胱穿刺造影检查3例；导尿管置于尿道外口附近，静脉注射造影剂5例；试插小儿导尿管18例；经阴道指检1例；26例均常规摄骨盆X线平片。根据临床症状、局部体征和检查情况，将损伤分为三类：尿道挫伤13例，有血尿，无明显排尿困难；部分断裂4例，有尿外渗，造影检查有造影剂外逸，但尿道连续性可见；完全断裂9例，造影剂外逸，尿道分离，尿道探子不能进入膀胱，且多合并有骨盆骨折及失血性休克。
1.2 治疗
作保留导尿管+抗炎治疗13例，单纯膀胱造瘘4例，尿道会师+牵引术9例。
2 结果
13例尿道挫伤作保留导尿管+抗炎治疗效果满意。4例部分断裂均作单纯造瘘，加强止血治疗，术后3周拔造瘘管[1] [2] 下一页
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