先天性尿道下裂术后尿瘘处理对策（附170例报告）  

Treatment of urethrocutaneous fistula after congenital hypospadias repair （ a report of 170 cases）

作　　者：张小明[1] 何恢绪[1] 胡卫列[1] 吕军[1] 聂海波[1] 李清荣[1] 王元利[1] 姚华强[1] 邱晓拂[1] 

机构地区：[1]广州军区广州总医院泌尿外科解放军下尿路疾病诊治中心,510010

出　　处：《中国医师进修杂志（外科版）》2007年第2期11-13,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 提高先天性尿道下裂术后尿瘘的治疗水平。方法 1997年1月～2005年12月，收治170例先天性尿道下裂术后尿瘘患者，其中瘘口位于阴茎阴囊交界处29例，阴茎体部106例，冠状沟下35例；1个瘘口者97例，2个以上瘘口者73例。简单尿瘘（简单组）适合于未进行过尿瘘修补术，阴茎体部或阴茎阴囊交界处1个或2个瘘口，但距离较近可融合成1个（最大直径小于1cm），既往尿道成形时新尿道板尚可应用、无尿道狭窄、尿道憩室者；采用荷包缝合法及Y—V成形法修补。复杂尿瘘（复杂组）适合于冠状沟下尿瘘，多次尿瘘术后尿瘘，多个瘘口且不能融合成1个者，瘘口直径大于1cm，尿道狭窄、尿道憩室，伴有阴茎下曲者；采用Mathieu法、Snodgrass法、阴囊皮瓣尿道成形术，再用肉膜蒂覆盖。结果 155例尿瘘患者一次修补成功，随访2个月至2年，立位排尿通畅。结论 先天性尿道下裂术后尿瘘的处理，简单尿瘘采用荷包缝合法及Y—V成形法修补；复杂尿瘘采用Mathieu法、Snodgrass法、阴囊皮瓣尿道成形术，再用肉膜蒂覆盖修补，效果满意。Objective To improve the treatment of urethrocutaneous fistula after congenital hypospadias repair. Methods One hundred and seventy patients of urethrocutaneous fistula after congenital hypospadias repair from January 1997 to December 2005 were reviewed retrospecstively. The average age of patients was （8.9 ±5.4）years. In 170 cases, 35 fistulae were at the coronary sulcus, 106 at the shaft of penis and 29 at the penoscrotal juncture. The fistula was single in 97 patients and multiple in 73. In simple fistula group, the fistulae was at the shaft of penis or penoscrotal juncture and with the maximum diameter no more than 1 cm, the urethral plate was available, there was no urethral stricture and urethral diverticulum. In the complicated fistula group, the fistula was at coronary sulcus with surgical history, which could not be confluenced into one. The maximum diameter of the fistula was more than 1 cm, the urethral plate was useless. There were urethral stricture and urethral diverticulum in this group. The simple fistula was treated with repairing by purse - string suture or Y - V shaping technique. The complicated fistula was treated with repairing by Mathieu technique, or Snodgrass technique, or septum of scrotum skin flaps to urethroplaaty and scrotum flaps to overjet it. Results All patients were followed up from 2 months to 2 years, 155 patients were cured at once. The miction was easy and smooth at stand position. Conclusions Urethrocutaneous fistula is one of the most common complication after congenital hypospadias repair. Purse - string suture or Y - V shaping technique is suitable for simple fistula repair; Mathieu technique, Snodgrass technique, septum of scrotum skin flaps to urethroplasty and scrotum flaps were suitable for complicated fistula repair.

关 键 词：尿道下裂 尿道皮肤瘘 手术 

分 类 号：R696[医药卫生—泌尿科学]