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损伤性后尿道闭锁尿道膀胱假道的诊治 |
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黄健 林天歆 沈昌理 郭正辉 梅骅
【编者按】在对后尿道狭窄患者进行尿道扩张时，由于方向不对，又施以暴力，常易形成假道。本例就是因早期处理不当，以致形成恒久的尿道膀胱假道，虽再次手术，由于未明确诊断，术中没有处理假道，导致手术失败。作者通过系列检查发现和确定假道的存在及其部位，并施行尿道假道横断及前后尿道吻合术，使尿道恢复连续性，取得了满意的效果。本文介绍的诊断方法及技术要点，值得学习和借鉴。
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摘 要：目的：探讨损伤性后尿道闭锁、尿道膀胱假道的诊治方法。方法：报告1例骨盆骨折致尿道断裂患者，因早期处理不当形成假道，再次行尿道修补仍不能恢复排尿通畅。经直肠指检、膀胱尿道造影、膀胱尿道镜检及前列腺部位的MRI检查明确诊断，并进行尿道假道横断及前后尿道吻合术。结果：术后14 d行膀胱尿道造影证实原假道消失，吻合口通畅，拔除导尿管后排尿通畅，尿线粗，无尿失禁。结论：前列腺部位的MRI检查有利于损伤性后尿道闭锁及尿道膀胱假道的诊断，尿道假道横断、前后尿道吻合术是治疗本症的有效方法。
关键词：尿道损伤 尿道闭锁 尿道吻合术
The diagnosis and treatment of injury posterior urethral atrasia
with urethrocystal artificial tract
HUANG Jian LIN Tian-xin SHEN Chang-li GUO Zheng-hui
(Department of Urology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University of Medicine Science，Guangzhou，510120)
MEI Hua
(Department of Urology,the First Affiliated Hospital,Sun Yat-sen
University of Medicine Science)
Abstract：Purpose：To study the diagnosis and treatment of injury posterior urethral atrasia with urethrocystal pseudotract. Methods：One case with posterior urethral disrupture caused by pelvic fracture was reported. Artificial tract was formed for the improper early treatment, the patient could not void fluently after the second urethral repair. Diagnosis was made by digital rectus examination, cystourethrography, cystourethroscopy and MRI of the prostate. The crosssection of the pseudotract and anastomosis of anterior and posterior urethral was performed . Results：The cystourethrography confirmed the disappearance of pseudotract and the fluency of the anastomosis site of in the 14th day after operation, the catheter was pulled out and the patient voided easily with rough stream without incontinence. Conclusions：Prostate MRI was helpful for the diagnosis of posterior urethral atrasia and urethrocystal pseudotract. The operation of crosssection of the urethral pseudotract, anastomosis of anterior and posterior urethra w[1] [2] 下一页
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