小儿Y型重复尿道畸形诊治(附13例报告)  被引量:1

Management of type Y urethral duplication in children: 13 cases report

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作  者:屈彦超[1] 张潍平[1] 孙宁[1] 田军[1] 李明磊[1] 宋宏程[1] 

机构地区:[1]首都医科大学附属北京儿童医院泌尿外科,100045

出  处:《中华小儿外科杂志》2016年第9期696-699,共4页Chinese Journal of Pediatric Surgery

基  金:北京市科技计划课题(Z131107002213128);首都医科大学博士点基金(2011110711007)

摘  要:目的探讨小儿Y型重复尿道的治疗方法,提高Y型重复尿道的诊疗水平。方法回顾性分析2005年6月到2015年6月收治的13例Y型重复尿道患儿的病历资料。本组均为男孩,就诊年龄1-15岁,平均5.5岁。主要表现为生后自会阴或肛门处排尿,其中4例合并阴茎下弯,其余可伸直,未发现阴茎背曲需要矫正者。术前常规检查包括排尿期膀胱尿道造影(VCUG)、静脉肾盂造影(IVP)及泌尿系超声,明确诊断及有无其他伴发畸形。共有12例进行手术,其中11例腹侧尿道为主尿道,一期行会阴部或阴茎根部尿道造口,二期成型自阴茎根部造口处到阴茎头之间的尿道;1例腹侧会阴部尿道发育纤细而背侧尿道发育正常行腹侧尿道切除术。1例就诊时在当地医院行会阴部瘘管切除术而将腹侧主尿道切除,长期进行尿道扩张治疗,未予处理。结果13例术后平均随访1-5年。4例经2次尿道成型术后治愈;二期术后发生尿道瘘5例,其中4例再次修瘘,1例待手术;2例二期术后出现尿道狭窄,经尿道扩张及内切开治愈。1例切除腹侧发育不良尿道者排尿正常,术后病理检查证实为移行上皮细胞。当地医院行会阴部瘘管切除术而将腹侧主尿道切除的患儿需每1-2周进行尿道扩张后可正常排尿。结论Y型重复尿道术前分清主副尿道至关重要,主尿道多位于腹侧,应用带蒂阴囊或包皮岛状皮瓣分期成形尿道可取得较好疗效。Objective To improve the diagnosis and management of type Y urethral duplication in children. Methods A total of 13 boys of type Y urethral duplication were recruited from 2005 to 2015. Their average presentation age was 5.5 (1-15) years. The major symptom was urination from perineum or anus. Four cases were complicated by chordee penis with insignificant dorsal deviated penis. Examinations included voiding cystourethrogram (VCUG), intravenous pyelography (IVP) and ultrasound for confirming other malformations. And 11 patients underwent 2-stage repair. Urethra was displaced from anal canal to perineum during initial surgery and urethral reconstruction during re- operation. One case of dysplasic ventral urethra was excised. And functional ventral urethra was excised in another patient of urethral perineum fistula. Results The follow-up period was 1 to 5 years. Four patients were successfully cured after 2-stage urethroplasty. Among 5 cases of urethral fistula, repair (n= 4)and observation (n = 1) were implemented. Urethral stricture developed in 2 cases of dilatation and internal urethrotomy. One case of excised ventral dysplasia urethra had excellent voiding while another case of excised functional urethra required dilatation every 2 weeks. Conclusions Prior to re-operation, it is essential to confirm functional urethra. Generally ventral urethra is the most functional and nedicle island flan urethronlastv is recommended_

关 键 词:重复尿道 排尿期膀胱尿道造影 治疗结果 

分 类 号:R726.9[医药卫生—儿科]

 

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