尿道下裂Duckett手术后吻合口狭窄的预防与治疗  

Prevention and management of anastomotic stenosis after hypospadias repair by Duckett’s operation

作　　者：徐奥 李雪[1] 曾莉[1] 黄一东[1] 马学[1] 黄鲁刚[1] Xu Ao;Li Xue;Zeng Li;Huang Yidong;Ma Xue;Huang Lugang(Department of Pediatric Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院小儿外科

出　　处：《临床小儿外科杂志》2019年第2期147-150,共4页Journal of Clinical Pediatric Surgery

基　　金：四川省科技重点研发项目(编号:2017SZ060)

摘　　要：目的探讨有效预防与治疗尿道下裂Duckett术后发生吻合口狭窄的方法。方法回顾性分析2007年9月至2017年9月在四川大学华西医院小儿外科经Duckett手术治疗的486例尿道下裂患儿的临床资料。结果486例患儿年龄1~14岁,平均年龄3.1岁,其中阴茎近侧型108例,阴茎阴囊交界型162例,阴囊型216例;重建修复尿道长度2.0~6.0 cm,平均3.4 cm。术后有37例发生排尿不畅,其中14例经局部表面麻醉下行尿道间断扩张处理缓解,9例在全麻下行尿道扩张置管并带管排尿,14例行尿道切开吻合口成形术,处理后均排尿通畅。本组发生真性尿道吻合口狭窄23例,发生率为4.7%。结论预防尿道下裂Duckett术后吻合口狭窄的关键是保护好皮瓣血液循环和近侧新尿道口的血供,保证适当大小的吻合口周径,精准严密的缝合和皮瓣筋膜蒂组织的覆盖保护。前尿道带管扩张和尿道吻合口切开成形术是治疗尿道下裂Duckett术后吻合口狭窄的有效方法。Objective To explore the effective methods for preventing and treating anastomotic stenosis after Duckett s procedure of one-stage urethroplasty for hypospadias.Methods A retrospective review was conducted for a total of 486 boys with hypospadias undergoing Duckett s procedure of one-stage urethroplasty between September 2007 and September 2017.Results The median age was 3.1(1-14)years.The clinical types of hypospadias included proximal penile(n=108),penoscrotal(n=162)and scrotal(n=216).All children underwent Duckett s procedure of one-stage urethroplasty successfully.The total neourethral length was 2 to 6 cm with a median of 3.4 cm.Thirty-seven cases experienced voiding difficulties.Among them,14 cases were relieved after urethral dilatation under local anesthesia;9 cases underwent urethral dilatation and a catheter was implanted through anastomotic stenosis under general anesthesia;14 cases had excision and anastomotic urethroplasty under general anesthesia.All cases urinated decently after operations.The incidence of anastomotic stenosis was 4.7%(23/486).Conclusion Adequate vascularization of flap and proximal neourethral meatus,optimal anastomotic diameter,precise suturing and protection of fascia pedicle can effectively reduce the occurrence of anastomotic stenosis.Urethral dilatation and anastomotic urethroplasty are efficacious for anastomotic stenosis.

关 键 词：尿道下裂 吻合口 手术后并发症 治疗 

分 类 号：R726.9[医药卫生—儿科] R691.1[医药卫生—临床医学]