一期经会阴膀胱颈折叠治疗女性尿道上裂  

Single-stage bladder neck plication via a perineal approach for female epispadias

作　　者：唐达星[1] 袁继炎[2] 吴德华[1] 刘平[3] 陶畅[1] 陈光杰[1] 

机构地区：[1]浙江大学医学院附属儿童医院泌尿外科,杭州310003 [2]华中科技大学同济医学院附属同济医院小儿外科 [3]温州医科大学育英儿童医院小儿科

出　　处：《中华小儿外科杂志》2014年第9期671-674,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨经会阴一期膀胱颈折叠术治疗女性尿道上裂术后的尿控及外阴外观效果。方法回顾性分析2008年4月、2009年11月和2012年2月分别收治的伴有完全尿失禁的尿道上裂女童3例的临床资料。此3例就诊年龄分别为3岁1个月、3岁8个月和4岁3个月；术前膀胱镜检查发现均尿道较短，3例从尿道外口至膀胱颈距离分别为1.8、2.3和1.5cm，膀胱颈异常宽大松弛；术前按国际儿童尿控协会推荐的尿控评估表来进行评估均为3级。本组均采用经会阴膀胱颈折叠术一期修复尿道上裂及外阴整形，其中第3例采用膀胱镜引导下重建膀胱颈。结果本组有2例术后出现间隙性膀胱痉挛，用抗胆碱能药物缓解，之后消失；未出现尿储留。3例分别在术后第13个月、16个月和2年获得良好的0级（2例）和1级（1例）尿控。3例术后均未出现尿路感染，家长反映患儿排尿时间明显较术前长，对外生殖器外观满意。结论采用经会阴一期膀胱颈折叠术治疗女性尿道上裂能获得良好的尿控和外生殖器外观。膀胱镜引导下行膀胱颈折叠能较好控制膀胱颈和尿道流出道阻力。Objective To evaluate urinary continence and cosmetic result of female epispadias managed by single-stage bladder neck plication via a perineal approach. Methods The clinical data of 3 female epispadias patients hospitalized with complete incontinence in April 2008, November 2009 and February 2012 respectively were reviewed. Their presentation ages were 37,44 and 51 months. Wide- open bladder neck and short urethra were observed under cystoscopy. And the distances between meatus and bladder neck were 1.8, 2.3 and 1.5 cm respectively. Preoperatively, grade 3 urinary incontinence was evaluated with the scoring system recommend by the International Children＇s Continence Society. Repairing epispadias and formalizing external genitalia of 3 cases were managed with single-stage bladder neck plication via a perineal approach. Bladder neck reconstruction of a third case was guided by cystoscopy. Results Postoperatively 2 girls presented with intermittent bladder spasm and released with anticholinergic drug. No urinary retention was observed. Good urinary continence of grade 0 （n = 2） and grade 1 （n = 1） was achieved at months 13, 16 and year 2 respectively. No urinary infection occurred. The parents found that voiding time of their children was longer than that of preoperation and external genitalias achieved satisfactory cosmetic appearances. Conclusions Good urinary continence and cosmetic appearance of external genitalia may be achieved with single-stage bladder neck plication for female epispadias via a perineal approach. Outlet resistance of bladder neck and urethra during bladder neck plication are manageable under cystoscopic guidance.

关 键 词：尿道上裂 尿失禁 泌尿外科手术方法 

分 类 号：R726.9[医药卫生—儿科]