膀胱尿道镜检术诊治重度尿道下裂合并前列腺囊的单中心临床研究  

Application of cystourethroscopy in the diagnosis and treatment of hypospadias with prostatic utricle

作　　者：涂磊[1] 赵夭望[1] 彭潜龙[1] 何军[1] 刘李[1] 殷波[1] 宁峰[1] Tu Lei,Zhao Yaowang,Peng Qianlong,He Jun, Liu Li, Yin Bo,Ning Feng.(Department of Urology,Hunan Children＇s Hospital,Changsha 410007,China. Corresponding author：Zhao Yaowang,Email：yw508＠ sina. Com)

机构地区：[1]湖南省儿童医院泌尿外科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2018年第7期510-513,共4页Journal of Clinical Pediatric Surgery

基　　金：湖南省自然科学基金面上项目(编号:2017JJ2139);湖南省卫生与计划生育委员会科研项目(编号:2014-125)

摘　　要：目的探讨膀胱尿道镜检术在重度尿道下裂合并前列腺囊诊治中的必要性和临床经验。方法回顾性分析本院收治的47例重型尿道下裂合并前列腺囊患者临床资料,年龄1.2~15岁,平均年龄2.8岁。其中尿道开口于阴茎阴囊交界处18例,开口于阴囊15例,开口于会阴部14例。47例均于尿道成形术前行膀胱尿道镜检术,其中3例行前列腺囊切除术。记录所有患者的临床资料,包括B超检查、影像学检查以及膀胱尿道镜检查结果,并进行分析。结果 47例重型尿道下裂患者通过膀胱尿道镜观察到前列腺囊大小不一,长度0.3~3.6 cm,以会阴型的前列腺囊长度最长。通过B超发现前列腺囊31例(59.5%),通过VCUG发现前列腺囊3例(6.4%)。临床表现为反复尿路感染、附睾睾丸炎4例(8.5%),其中3例行腹腔镜下膀胱镜辅助前列腺囊切除术,术后随访临床症状消失,1例拒绝手术,随访中仍存在反复感染症状。结论膀胱尿道镜检术能准确发现尿道下裂患者的前列腺囊,并能测量前列腺囊的大小、位置。在前列腺囊切除术中,膀胱尿道镜辅助腹腔镜操作,能准确显示前列腺囊的位置,有助于精准完整地切除前列腺囊。Objective To explore the necessity and application of cystourethroscopy in the diagnosis andtreatment of hypospadias with prostatic utricle. Methods A total of 47 patients of severe hypospadias withprostat ic utricle were recruited. The average age was 2. 8（1. 2 ～ 15） years. The locations of urethral orifice wereat the junction of penis ＆ scrotum （n = 18）,scrotum （n = 15） and perineum （n = 14）. Prior to urethroplasty,cystourethroscopic examination was performed. Three of them underwent cystoscopicassisted laparoscopic excision of prostatic utricle. Clinical data and results of ultrasound,imaging examinations and cystourethroscopic examination were recorded. Results Under cystourethroscope,the sizes of prostatic utricle varied greatly. Thelength was 0. 3 ～ 3. 6 cm and the length of perineum was the longest. Among them,31 cases of prostatic utriclewere detected by ultrasound （59. 5%）. Three patients （6. 4%） had prostatic utricle on voiding cystourethrography （VCUG）. Among 4 patients （8. 5%） with epididymitis,3 underwent cystoscopicassisted laparoscopicexcision of prostatic utricle and the symptoms disappeared during postoperative followups. One case refusedsurgery and developed recurrent infection. Conclusion Cystourethroscopy may detect prostatic utricle in patients with hypospadias and it can measure the size and location of prostatic utricle while other examinationstend to miss its diagnosis. During cystoscopicassisted laparoscopic excision of prostatic utricle,cystourethroscopic assistance may facilitate countertraction movements and accurate dissections.

关 键 词：前列腺囊 尿道下裂 膀胱尿道镜 

分 类 号：R726.9[医药卫生—儿科]