骨盤骨折に伴う尿道断裂の内視鏡的再建術

ENDOSCOPIC RECONSTRUCTION OF URETHRAL DISRUPTION ASSOCIATED WITH PELVIC FRACTURE

　外傷性尿道断裂後の尿道閉塞5例に内視鏡的尿道再建術を行った．膜様部損傷3例，球部損傷2例であった．受傷3〜6ヵ月後，腰椎麻酔下に手術を行った．平均手術時間は74分で術中輸血を要した症例はなかった．2例に内尿道切開術の追加を要したが，全例自排尿可能になった．前立腺萎縮と神経因性膀胱合併の1例を除く4例の最大尿流率は10〜27ml／秒（平均18.3ml／秒）と良好であった．軽度の腹圧性尿失禁を2例に認めた．手術に起因するインポテンツはなかった．本法は比較的簡便で手術侵襲が少なく，3cm以下の尿道閉塞には尿道形成術に替わり得る有効な術式と考えられた．

We report the results of endoscopic reconstruction of traumatically disrupted urethra in five patients aged from 18 to 74 years (average 36.8 years old). Membranous urethra was disrupted in three patients and bulbar urethra in two patients. Three to six months after cystostomy, the operation was performed under spinal anesthesia. Operation time was 40-120 minutes (average 74 minutes) and the operation did not require blood transfusion. Additional internal urethrotomy was needed in two patients but all five patients could void transurethrally. Two patients had slight stress incontinence.