复杂器质性尿道狭窄行尿道扩张并发直肠损伤8例分析

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1、复杂器质性尿道狭窄行尿道扩张并发直肠损伤8例分析【摘要】目的：探讨复杂器质性尿道狭窄行尿道扩张并发直肠损伤发生的原因、诊治及预防。方法：对笔者所在医院2000年1月-2015年1月收治的复杂器质性尿道狭窄行尿道扩张术并发直肠损伤的8例患者进行回顾性分析。结果:8例术中均在斑马导丝引导下留置尿管。1例行乙状结肠造口，一期直肠创口清创缝合；3例行剖腹探查，腹膜未受损伤，腹腔均未受手术污染，未行结肠造口；4例未行剖腹探查，未行结肠造口。8例留置尿管9周后，拔出尿管，均未出现尿道直肠瘘，8例预后均良好。结论:复杂器质性尿道狭窄

2、行尿道扩张并发直肠损伤多在术中发现，暴力操作是主要原因。对于未损伤腹膜、未贯穿腹腔、肠道清洁的患者，可留置尿管观察，必要时行直肠创口清创缝合术和结肠造口术，术后给予胃肠道减压、积极抗炎、肠外营养，预后均良好。严格把握尿道扩张适应证，规范操作是预防直肠损伤的关键。对于狭窄段较长者，建议行尿道狭窄段切除端端吻合术或者经尿道尿道狭窄段内切开术。【关键词】尿道狭窄；尿道扩张术；直肠损伤中图分类号R691.1文献标识码B文章编号1674-6805(2016)29-0011-03OrganicComplexUrethralStri

3、ctureUrethralDilationConcurrentRectalInjuryin8Cases/HEHao-yang，LILi-yu，TAOZhi-xing,etal.//ChineseandForeignMedicalResearch,2016,14(29):11-13【Abstract】Objective：Toinvestigatethereasonofrectalinjury，diagnosis，treatmentandpreventionofcomplexorganicurethraldilationu

4、rethralstricture.Method：FromJanuary2000toJanuary2015，eightcaseswithcomplexorganicurethralstrictureconcurrentrectalinjuryinourhospitalwereretrospectivelyanalyzed.Result：8caseswereallinzebraindwellingcatheterguidewireunder.Aroutinecolostomy，arectalwounddebridement

5、,3routinelaparotomy，peritonealintact，abdominalsurgerywerenotaffectedbypollution，didnotundergocolostomy,fourcasesdidnotundergolaparotomy，didnotundergocolostomymouth.Afternineweeksindwellingcatheter，pulloutthecatheter，nourethralfistula，eightcasestheprognosiswerego

6、od.Conclusion：Organiccomplexurethralstrictureurethraldilationmultipleconcurrentrectalinjuryduringsurgeryisfoundthatviolentaction，itisthemainreason.Fornotdamagetheperitoneum，notthroughtheabdominalcavityinpatientswithbowelcleansingcanobserveindwellingcatheter，ifne

7、cessary，rectalwounddebridementsurgeryandcolostomy，aftergivinggastrointestinaldecompression，positiveanti-inflammatory，bowelnutrition，theprognosisisgood.Strictlycontrolurethralindicationsandstandardsarekeytopreventingrectalinjury.Forthestrictureislonger，itisrecomm

8、endedurethralstrictureresectionanastomosisortransurethralincisionofurethralstricture.【Keywords】Urethralstricture；Urethraldilation；RectalinjuryFirst-author'saddress：Qu