尿道损伤的诊断治疗现状

尿道损伤一直是个棘手的泌尿外科常见疾病。逆行尿道造影是评价尿道损伤的金标准。尿道损伤的治疗方法的选择在泌尿系创伤中是争议最多的。目前没有一种方法是最简单有效的处理方法。组织工程技术的诞生和发展,给尿道损伤的处理带来了新的希望,有望为尿道损伤的修复提供新的材料。本文仅就尿道损伤疾病的基本概况及国内外在诊断和治疗方面的的研究现状作简要综述。     

The Management of Lower Extremity Multilevel Arterial Injuries: A 10-Year Experience

Background

Limb amputation due to lower extremity arterial injury is not uncommon and multilevel arterial injury is even more limb-threatening and easily missed with potentially devastating consequences. There is limited information on multilevel arterial injuries.

Purpose

We undertook a review of our experience to gain insight on multilevel arterial injury patterns associated with lower extremity trauma and to analyze the results of management of such injuries with a special focus on the influence of initial diagnosis on limb salvage.

Patients and Methods

Between August 2002 and September 2012, 38 patients with lower extremity multilevel arterial injuries were reviewed, retrospectively. The injury patterns and amputation rates associated with initial diagnosis or misdiagnosis were analyzed.

Results

According to their injury levels, three multilevel arterial injury patterns were seen in this series: arterial injuries with the involvement of femoral artery and popliteal artery (pattern A), femoral artery and anterior or (and) posterior artery (pattern B), and popliteal artery and anterior or (and) posterior artery (pattern C). The general missed diagnosis rate was 31.6%. Pattern B had a much higher missed diagnosis rate than the other two patterns. The missed diagnosis rate was significantly correlated with the amputation rates (Odds Ratio =10.7, 95% CI: 2.04-56.61). The definite diagnosis rate was only 14.8% using duplex ultrasonography examination.

Conclusions

Diagnosis of pattern B injury is more prone to be missed. DUS has low specificity in the detection of multilevel arterial injuries. Aggressive intraoperative exploration is considered to be valuable in the definitive diagnosis of highly suspected cases when other diagnostic tools are unavailable.