成人先天性尿道下裂术后尿瘘的治疗  

Treatment of urethrocutaneous fistula after congenital hypospadias repair in 25 adults

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] 杨槐[1] 

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

出　　处：《第三军医大学学报》2008年第23期2236-2237,共2页Journal of Third Military Medical University

摘　　要：目的探讨25例成人先天性尿道下裂术后尿瘘的治疗方法及其效果,以期提高治疗水平。方法从1997年1月至2006年12月收治的25例成人先天性尿道下裂术后尿瘘患者,瘘口位于阴茎阴囊交界处10例,阴茎体部7例,冠状沟下8例;1个瘘口者7例,2个以上者18例。简单尿瘘(9例)采用Y-V成形或TIP术治疗,复杂尿瘘(16例)采用Mathieu法或TIP术或阴囊中隔尿道成形及肉膜蒂加盖术。结果术后随访6个月至2年,22例患者1次手术成功。结论充分的术前准备、选择正确的手术方法及尿道成形材料、充分有效的尿转流及术后细致的护理,是尿瘘修补成功的重要要素。阴茎无下曲、阴茎皮肤充裕、远端尿道尚可应用的尿瘘患者,采用Y-V成形或TIP术;远端尿道闭锁/狭窄或阴茎皮肤瘢痕多、皮肤不充裕伴阴茎下曲的患者,采用Mathieu法、TIP术或阴囊中隔尿道成形术,肉膜蒂加盖:均是行之有效的方法。Objective To analyze the treatment of urethrocutaneous fistula after hypospadias repair in 25 adults for a better approach. Methods We subjected 25 adult patients who suffered from urethrocutaneous fistula after congenital hypospadias repair from 1997 to 2006 in our hospital. Of 25 patients, at the mean age of 26, there were 8 coronary sulcus type, 7 penile type, and 10 penoscrotal type. Seven cases had only one fistulous orifice, and 18 had two or more orifices. The simple fistula （9 cases） were repaired with transverse Y-V advancement flap or TIP operation; The complicated fistula were treated with Mathieu technique, TIP technique or pedicled scrotal septum flap and covered with dartos-based flip flaps. Results There were 22 patients having good outcome at once, 2 receiving second operation, and the left 1 was recovered after 4 times＇ operation. There was no any complication during the follow-up of 6 months to 2 years. Conclusion The surgical treatment for urethrocutaneous fistula after hypospadias repair should be carried out according to the site of fistula and completed status. The simple fistula should be repaired with transverse Y-V advanced flap or TIP technique. Mathieu technique, TIP technique or pedicled scrotal septum flap and covered with dartos-based flip flaps are suitable for complicated fistula.

关 键 词：尿道下裂 尿瘘 成人 

分 类 号：R619[医药卫生—外科学] R695[医药卫生—临床医学]