整形外科学原则在尿瘘修复中的应用  

The principles of plastic surgery in the management of urethrocutaneous fistulae

作　　者：刘立强[1] 李森恺[1] 李养群[1] 卜照云[2] 范金财[1] 王永前[1] 徐家杰[1] 周传德[1] 杨明勇[1] 

机构地区：[1]中国医学科学院中国协和医科大学整形外科医院,北京100041 [2]山东省日照市人民医院小儿外科

出　　处：《中华泌尿外科杂志》2006年第2期131-134,共4页Chinese Journal of Urology

基　　金：卫生部临床学科重点项目基金资助(20010409);高校博士点基金资助项目(20010023002)

摘　　要：目的提高尿瘘修复手术成功率。方法采用指钩、旋转和嵌入等三维缝合法进行尿瘘修复93例(131处瘘口)作为研究组,其中一期尿道成形患者52例,按瘘口位置分为冠状沟型19例,阴茎型17例,阴茎阴囊交界型12例,会阴型4例;因尿道再造材料不足和尿道废用需分期行尿道吻合者41例,瘘口均位于阴茎阴囊交界部位。对照组为1996年1月至2000年1月应用间断缝合法修复尿瘘患者85例,冠状沟型23例,阴茎体型19例,阴茎阴囊交界型33例,会阴型10例,瘘口共98处。2组患者均应用局部筋膜和皮瓣组织进行修复。术后观察患者排尿时尿线、排尿通畅情况及有无尿瘘发生,应用尿道镜对修复尿道进行观察;尿瘘修复成功标准为排尿通畅,无尿瘘及尿道狭窄发生。结果研究组瘘口一次修复成功率87.7%(115/131),复发瘘经换药自行愈合率56.3%(9/16),总愈合率94.6%(124/131);对照组分别为75.5%(74/98)、25.0%(6/24)、81.6%(80/98)。尿道镜观察见尿瘘修补处无狭窄,壁光滑,缝线已脱落。结论尿瘘手术操作应遵循整形外科学原则,旋转与嵌入缝合法符合组织移植成活规律,可提高尿瘘修复成功率。Objective To improve the success rate of the urethrocutaneous fistula repairing. Methods Guided by the principles of plastic surgery,ie,sterile, atraumatic and tension-free procedure,93 patients with urethrocutaneous fistula （study group） were treated with the patent instrument and the 3-dimensional suture methods for repair （finger claw, rotation and interposition）. The fistulae were divided into 4 types by the location of fistula： coronal （ n = 19 ）, penile （ n = 17 ）, penioscrotal （ n = 12 ）, perineal （ n = 4）. The urethral anastomosis of staged urethroplasty due to the lack of the local reconstructive tissue and the handicapped hypospadias were completed in 41 patients;in them the fistula orifices were all located at penioscrotal site. Altogether there were 131 fistulae. As control group,85 patients with fistula （98 fistulae in all） were treated by interrupted suture method for repair between 1996 and 2000, including ： coronal （ n = 23 ）, penile （ n = 19）, penioserotal （ n = 33 ）, perineal （ n = 10） types. All of the fistulae in the 2 groups were repaired with local fascia and skin flap. The repaired urethras were checked by urethroscopy and the urination and urinary stream were observed after operation. The success Criteria were defined as free urination, and no occurrence of urinary fistulae and urethral stricture. Results The success rate of primary fistula repair was 87.7% （ 115/131 ） in study group and 75.5% （74/98） in control group;the rate of recurrent urethrocutaneous fistula healing spontaneously was 56.3% （9/16） in study group and 25.0% （6/24） in control group; and the total healing rate was 94.6% （ 124/131 ） in study group and 81.6% （ 80/98 ） in control group, respectively. No urethral stricture was found and the wall was smooth with the suture coming off in the repair area by urethroscopy examination. Conclusions The principle of plastic surgery must be followed seriously in operative procedure. The rotation and interposition

关 键 词：尿道狭窄 尿瘘 外科整形 手术成功率 

分 类 号：R699[医药卫生—泌尿科学]