先天性前尿道皮肤瘘的治疗分析  

Diagnosis and treatment of congenital anterior urethrocutaneous fistula

作　　者：白明[1] 康磊[1] 张高峰[1] 张敬悌[1] 郭涛[1] 明星[1] 王议鹤 周延岩 Bai Ming;Kang Lei;Zhang Gaofeng;Zhang Jingti;Guo Tao;Ming Xing;Wang Yihe;Zhou Yanyan(Department of Urology,Xi’an Children’s Hospital,Children’s Hospital Afficiated to Xi’an Jiaotong University,Xi’an 71003,China)

机构地区：[1]西安交通大学附属儿童医院西安市儿童医院泌尿外科,西安710003

出　　处：《中华泌尿外科杂志》2022年第1期62-66,共5页Chinese Journal of Urology

摘　　要：目的探讨先天性前尿道皮肤瘘的临床特征和治疗策略。方法回顾性分析2006年1月至2019年2月西安交通大学附属儿童医院采用手术治疗的7例先天性前尿道皮肤瘘患儿的临床资料。中位年龄30(18~92)个月。7例尿道外口均位于阴茎头顶端且包皮完整。瘘口位置:冠状沟下2例, 阴茎中段3例, 阴茎阴囊交界处1例, 阴囊1例。瘘口长径中位值1.0(0.5~1.5)cm。3例伴阴囊纵裂, 2例伴阴茎下弯, 1例伴尿道外口轻度狭窄, 1例伴右侧鞘膜积液。6例行一期修复术:4例(例1、2、4、6)尿道板发育好, 采用Duplay法;例3和例5尿道板较窄, 分别采用Onlay法和TIP法, 其中例5同时行阴茎背侧海绵体折叠及尿道口切开术。例7因重度阴茎下弯需切断尿道板行分期手术:一期Duckett法+近端尿道造口, 二期行造口关闭术。尿道采用尿道周围筋膜、阴囊肉膜或包皮带蒂肉膜等软组织进行覆盖。结果 6例一期完成修复手术患者中, 5例于术后10~14d拔除尿管, 例3术后阴茎皮肤愈合欠佳, 予对症治疗, 尿管延长至3周拔除。例7一期手术后恢复满意, 7个月后行二期造口关闭术, 术后2周拔管。术后随访1~8年, 7例排尿均正常, 无尿道瘘、尿道狭窄或阴茎下弯。结论先天性前尿道皮肤瘘可合并阴茎下弯、尿道下裂以及阴囊纵裂等畸形, 部分病例在初期表现为尿道憩室;总体手术效果好, 对于无阴茎下弯、尿道板发育好且周围筋膜组织丰富者, 可行Duplay法修复;尿道板较窄者可采用Onlay法或TIP法修复;合并重度阴茎下弯者应切断尿道板, 按照尿道下裂手术方式进行修复。Objective To explore the clinical features and treatment strategy of congenital anterior urethrocutaneous fistula.Methods A total of 7 cases with congenital anterior urethrocutaneous fistula were repaired by surgery between January 2006 and February 2019 in Affiliated Children’s Hospital of Xi’an Jiaotong University.The median age was 30(18-92)months.All of cases had a intact prepucs and a normal external urethal meatus located at the tip of glans.Fistula located at subcoronal culus in 2 cases,midshaft in 3 cases,penioscrotal region in 1 case,scrotum in 1 case,respectively.Defect longitudinal diameter was 0.5-1.5cm.Associated anomalies including division of scrotum in 3 cases,penile chordee in 2 cases,urethral meatus stenosis in 1 case,right hydrocele in 1 case.Six cases had underwent one-stage fistula repair incluing Duplay procedure in 4 cases(case 1,2,4 and 6),Onlay preputial flap in 1 case(case 3),TIP repair with dorsal plication for straightening and urethrotomy in 1 case(case 5).Case 7 had underwent a two-stage repair,which received Duckett flap repair with urethrostomy simultaneously at the base of the penis,and the defect was closed in second procedure.All of neourethras were reinforced by soft tissues from different places.Results Of 6 cases with one-stage repair,the catheter was removed 10-14 days after surgery in 5 cases.Removal of the catheter was delayed until 3 weeks in case 3 because of poor wound healing.Case 7 received Duckett flap repair with urethrostomy in the initial surgery,who recovered uneventfully and was resolved during the second operation.No recurrence,urethral stricture or chordee occurence were noted in all after a 1-8 years followup period.Conclusions Congenital anterior urethrocutaneous fistula have a high overall success rate.Duplay could be applied to cases without penile curvature,and well-developed urethral plate.Onlay or TIP is more suitable for cases with narrow urethral plate.The principle of hypospadias repair should be followed for those cases with severe penile curvat

关 键 词：先天性 前尿道 尿道瘘 手术 

分 类 号：R699.6[医药卫生—泌尿科学]