儿童骨盆骨折并尿道损伤的处理

摘要

骨盆骨折合并尿道损伤(PFUI)的修复一直以来都是挑战泌尿外科医师水平的棘手难题,儿童由于前列腺发育尚不成熟,尿道损伤的程度较成人往往更严重,加之儿童尿道纤细,其修复较成人更难.目前,治疗时机、方法尚未达成共识.现通过分析PFUI的病理机制、临床表现、诊断,特别是目前的治疗方法,提出该病的治疗原则,即PFUI是否采取急症处理方式,需根据具体情况决定,无需统一.若患儿伤情和医师技术水平2项基本条件均具备,应提倡急症经会阴一期手术吻合尿道.有一项欠缺以单纯膀胱造瘘为好,同时可积极创造条件,选择延迟手术一期尿道修复.%Surgical treatment of pelvic fracture-associated urethral injury(PFUI) continues to be a difficult problem to be solved in urology.Children with an immature prostate and puboprostatic ligament may suffer from posterior urethral disruptions in a manner different from adults.Considering these distinctions,the management of pediatric PFUI presents a challenge for urologist as no consensus or algorithm has been proposed or accepted.Now,through analyzing the pathogenesis,presentation,diagnosis and treatment of PFUI,give the principle of the management.The choice of immediate repair or delayed repair should be decided according to the particular situation.Immediate Ⅰ stage anastomosis of urethra for PFUI is recommended when the patient's condition is stable,serious complications are treated,and the surgeon is experienced.If the patient's condition is unstable or no experienced urologist is available,a suprapubic catheter should be placed for bladder decompression and try to get a good condition for delayed urethroplasty.