肛管直肠膀胱后尿道贯通伤的诊治

目的 探讨肛管直肠膀胱后尿道贯通伤的诊断与治疗。方法 回顾性总结1995年－2000年肛管直肠膀胱后尿道贯通伤12例，行肛管直肠膀胱伤口清创缝合，粪便尿液有效转流、充分骶前引流。结果 本组12例均治愈，其中2例术后并发骶前间隙感染，经充分引流而愈；1例肛门括约肌修补失败，行Ⅱ期修补治愈；1例发生直肠膀胱瘘，保守治疗而愈。无肛门狭窄、排尿困难、阳瘘等并发症。结论 掌握肛管直肠膀胱后尿道贯通伤的临床特点，及时作出准确诊断，选择合理的手术方案，加强围手术期治疗，是提高疗效的关键。

Diagnosis and treatment of penetrating wounds in anorectum and postvesicular urethra

Objective To evaluate the diagnosis and treatment of penetrating wounds in anorectum and postvesicular urethra. Methods A total of 12 cases of penetrating wounds in anorectum and postvesicular urethra from the year of 1985 to 2000 were analyzed retrospectively. Debridement and suture for the anorectal and vesical wounds, effective shunt of stools and urine, and full presacral drainage were performed on all the cases. Results All the 12 cases were cured. Among them, 2 had postoperative infection in the anterior sacral space and were cured by full drainage, 1 was cured by secondary repair after the anal sphincter being repaired unsuccessfully, and 1 of rectovesical fistula was cured by conservative treatment. None of them suffered from anal stenosis, dysuria or impotence. Conclusions To master the clinical features of the disease, to diagnose correctly in the early stage and to select reasonable operative procedures are the keys to improve the curative effect of penetrating wounds in anorectum and postvesicular urethra.