医源性尿道直肠损伤

目的 探讨医源性尿道直肠损伤的治疗方法。方法 分析13例医源性尿道直肠损伤的临床资料，治疗包括：一期尿道直肠修补4例；耻骨上膀胱造瘘＋乙状结肠造瘘8例；单纯耻骨上膀胱造瘘1例；二期经会阴或联合肛直肠睡行尿道直肠瘘修补6例。结果 一期尿道直肠修补4例均未发生尿道直肠瘘，3例治愈，1例发生尿道狭窄。9例尿道直肠瘘经粪尿分流，3例（33％）尿道直肠瘘愈合，其中2例发生尿道狭窄。6例经会阴或联合肛直肠径路行瘘修补或瘘修补＋尿道吻合术，均治愈。结论 尿道直肠损伤后应尽早发现并作一期缝合修补，可避免尿道直肠瘘发生；粪尿分流可使部分瘘闭合；经会阴联合肛直肠径路行尿道直肠瘘修补具有损伤小、暴露好等优点，特别适于合并后尿道狭窄的患者。

Management of iatrogenic rectourethral injury

Objective To improve the level of the treatment of iatrogenic rectourethral injury.?Methods We treated 13 men with iatrogenic rectourethral injury. The treatment included primary closure in 4 patients, suprapubic cystostomy and end sigmoid colostomy in 8 patients, suprapubic cystostomy only in 1 patient.?Six patients underwent repair via transperineal or combining transanorectal approach.?Results The 4 cases who received primary closure were cured, but urethral stricture developed in 1. In 3 patients (33%) the fistula healed after diversion but the urethral stricture developed in 2. In 6 patients who underwent repair via transperineal or combined transanorectal approach,the fistula resolved.?Conclusion It is believed that the involved in the treatment of iatrogenic rectourethral injury lies in early diagnosis and repair. Fecal and urinary diversion has resulted in resolution in some fistulae. Combining transperineal and transanorectal incision provided good visualization and safety in treatment of rectourethral fistula.