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尿道下裂术后尿道狭窄的治疗 |
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方卫华 于德新 王克孝 周礼生
摘 要：目的：探讨尿道下裂尿道成形术后尿道狭窄的治疗。方法：对尿道下裂尿道成形术后发生尿道狭窄29例患者临床资料进行分析。结果：尿道外口狭窄21例，其中11例经扩张治愈，另10例分别行狭窄的外口切开及狭窄段切除阴茎包皮转移皮瓣尿道外口整形术。吻合口狭窄8例，对其中2例行吻合口狭窄直接扩张，另6例行狭窄部切除端端吻合术，均获成功。结论：尿道下裂尿道成形术后尿道狭窄发生的主要原因是成形尿道皮瓣的设计不合理、血供差、感染、原尿道外口狭窄或发育不良处未切除以及缝合材料选用不当。对尿道外口狭窄主要行扩张治疗，对吻合口狭窄应以手术治疗为主。
关键词：尿道下裂 尿道狭窄 尿道成形术
Treatment of urethral stricture after hypospadias repair
FANG Wei-hua YU De-xin WANG Ke-xiao
(Department of Urology,the First Affiliated Hospital,Anhui Medical University,Hefei,230022)
ZHOU Li-sheng
(Department of Surgery,the People′s Hospital of Huaining County Anhui Province)
Abstract：Purpose：To discuss the treatment of urethral stricture occurred after urethroplasty in hypospadias. Methods：The clinic data of 29 cases of urethral stricture after urethroplasty in hypospadias patients were analyzed. Results：In 21 cases with urethral meatus stricture,11 were dilated,10 strictured segments were excised and reconstructed using pedicle island flap plasty. In 8 cases with anastomosis site stricture,2 were dilated,6 were treated with Termino-terminal anastomosis. All patients were successful. Conclusions：The main causes of urethral stricture of hypospadias urethroplasty are incorrect design of pedicle island flap, short blood supply of the flap, infection and the improper suture material. Urethral meatus stricture were treated mainly by urethral dilation, and anastomosis site stricture by operation.
Key words：Hypospadias Urethral stricture Urethroplasty▲
尿道狭窄是先天性尿道下裂术后最常见的并发症之一，直接关系到手术的成败，临床处理非常棘手。我院1985～1999年施行尿道下裂尿道成形术215例，其中术后发生尿道狭窄29例，现结合文献就其发生原因、预防及治疗方法报告如下。
1 资料与方法
1.1 一般资料
本组29例，年龄3～18岁。其中发生尿道外口狭窄21例，吻合口狭窄8例。尿道狭窄主要发生在两个时期，一是发生在术后拔除造瘘管后，主要为吻合口狭窄及由成形尿道成角扭曲导致；二是发生在术后3个月以后，主要以尿道外口狭窄多见。本组29例尿道狭窄均表现不同程度的排尿困难，其中8例吻合口狭窄主要表现为用力排尿但尿淋沥不尽，点滴状流出不成线(其中1例因用力排尿近端尿道扩张明显形成假性尿液囊肿)，用尿道探子探查时尿道外口无狭窄但吻合口处不能通过，尿道造影可明确诊断。21例尿道外口狭窄主要表现是术后早期排尿开始通畅，嗣后尿线逐渐[1] [2] 下一页
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