膀胱软镜在骨盆骨折后尿道狭窄患者中的应用及疼痛耐受性研究

Clinical application and pain tolerance of flexible cystoscopy in pelvic fracture urethral distraction defects stricture

摘要:

目的??研究膀胱软镜在骨盆骨折后尿道狭窄患者中的应用价值并对接受镜检患者的疼痛耐受性情况进行比较分析。方法?120例男性骨盆骨折后尿道损伤（PFUDDs）导致尿道狭窄患者，平均年龄（36.2±9.5）岁（20～58岁）。87例患者接受膀胱软镜检查，33例患者行膀胱硬镜检查，所有患者接受膀胱尿道镜检查完善膀胱、后尿道情况。对膀胱及后尿道结石、膀胱颈部结构异常、后尿道假道、尿道直肠瘘的检查结果与传统的尿道造影检查进行比较分析。依据视觉模拟疼痛评分量表（VAS）对检查中、检查后1天的疼痛情况进行疼痛评分，对膀胱软镜与传统硬镜检查的疼痛评分情况进行分析并比较两组间的差异。结果?膀胱软镜检查可以更直观地了解尿道狭窄位置、后尿道结构、膀胱及膀胱内结石等异常情况，通过镜检发现后尿道内结石、膀胱颈部结构异常、后尿道内假道、尿道直肠瘘瘘口分别为21、5、7和5例，与传统的影像学检查异常发现情况比较差异有统计学意义。进行膀胱软镜检查时经尿道及经膀胱造瘘口的疼痛评分明显低于硬镜检查，检查后的延时疼痛评分比较均显示差异有统计学意义。结论?对骨盆骨折后尿道狭窄患者进行传统影像学检查的基础上，膀胱软镜检查能提供更全面、更有效的术前评估。患者对检查的疼痛耐受性高，对疾病正确诊治有较高的临床价值，是值得推广的术前检查方法。

Abstract:

Objective?To study the value of flexible cystoscopy in diagnosing posterior urethral strictures resulting from pelvic fracture and the pain score of the examination.?Methods?Between 2014 and 2015, 120 male patients with pelvic fracture urethral distraction defect were evaluated by cystoscopy before surgery. In this study, flexible cystoscopy was used in 87 patients, 33 patients received conventional rigid cystoscopy. The cystoscopy was introduced into the posterior urethra and the area was evaluated for the length of the proximal urethra and any possible fistulas, false passages, calculi or displacement of the posterior urethra. The patient’s pain feeling was recorded during the examination, 24 hrs after cystoscopy examination. The pain feeling result was achieved by visual analogue pain scale.?Results?Severe allergic reaction or obvious discomfort did not occur in any patients after cystoscopy. By comparing the data obtained from flexible cystoscopy to those from conventional urethrography, the rate of detection in other abnormalities was higher in flexible cystoscopy than in conventional urethrography. 21, 5, 7 and 5 patients were detected with calculus, posterior urethral structure damage, false passage and fistula respectively. In comparison, the abnormalities were only observed in 3, 2, 3 and 1 patients respectively through conventional urethrography imaging. However, the pain feeling of the flexible cystoscopy is better than the convenional rigid cystoscopy. The statistical difference was found in the pain feeling score during the examination and later after the examination.?Conclusions?Flexible cystoscopy is a safe and valuable procedure in the evaluation of the posterior urethra in patients with pelvic fracture urethral distraction defect before surgery.