【摘要】 目的　探讨儿童后尿道损伤更为有效的诊治方法和并发症的防治。方法　回顾性总结分析 1990年 4月～ 2 0 0 3年 12月四川大学华西医院收治的 5 5例儿童后尿道损伤的临床资料 ,38例( 6 9.0 % )获得 6个月～ 14年 (平均 6年 4个月 )的随访。结果　本组几乎均为陈旧性后尿道损伤。尿道狭窄组 10例行尿道带管扩张 ,7例治愈 ,3例改行尿道拖入吻合术 ;尿道闭锁组 ,采用后尿道拖入吻合术 2 9例 ,近期成功率 10 0 % ,远期结果 ,排尿欠通畅 3例 ,部分性尿失禁 4例 ,反复发生附睾炎 2例 ,阳痿 2例 ;经耻骨后尿道成形术 14例 ,近期成功率 86 % ,远期结果 ,排尿困难 2例 ,排尿欠通畅 2例 ,不完全性尿失禁 2例 ,附睾炎 1例 ,阳萎 1例 ;3例阴囊中缝皮瓣拖入间置术中 ,2例发生间置尿道狭窄 ;2例经会阴尿道吻合术疗效满意。结论　尿道狭窄经恰当处理后会有良好的效果 ;经会阴后尿道拖入吻合术在儿童后尿道闭锁的治疗中效果满意 ,经耻骨后尿道吻合术更适用于较复杂的后尿道闭锁治疗 ;我们赞同儿童后尿道断裂伤后早期即时的耻骨上膀胱造瘘 ,延期尿道修复手术的观点更多还原

【Abstract】 Objective To review the results of the operative treatment for childhood posterior urethral injuries.Methods The clinical data of 55 children with posterior urethral injuries from April 1990 to December 2003 in West China Hospital of Sichuan University were analyzed. Thirty-eight cases (69%) have been followed-up from 6 months to 14 years (means 6 years and 4 months).Results Of them, 49 cases were boys and 6 cases were girls, the mean age was 8 years (from 3 to 14 years). Forty-nine cases (89%) were as a result of pelvis fracture, 4 cases with posterior urethral defect and rectourethral fistula after surgical operation for anorectal malformation, and the other 2 girls due to perineal trauma. Most of them were hospitalized for urethral stricture or obliteration. Out of 10 cases with posterior urethral stricture were treated by urethral dilatation, 7 cases were recovered, while 3 cases turned to pull-through procedure. Twenty-nine cases with posterior urethral defects were treated by pull-through procedure. The early success rate was 100%. During follow-up term, there were 3 cases with some difficulties in void, 4 with partial incontinence, 2 with epididymitis, and the other 2 with impotence. Fourteen cases with urethral defects underwent to transpubic urethroplasty with 86% of early success rate. And there were 2 patients complained of some difficulties in void, 2 with partial incontinence, 1 with epididymitis and the other one with impotence during long-term follow-up. Among 3 boys with long defect of posterior urethra underwent to scrotal flap interposition, 2 cases were complicated with urethral stricture after operation. And 2 patients who underwent perineal urethroplasty were recovered without any complaint.Conclusions The good results can be gained through appropriate treatment for children with posterior urethral injuries.更多还原