一期手术修复膀胱外翻的远期疗效

Long-term Outcome of One Stage Operation to Repair Bladder Extrophy

目的:评估简化的一期手术修复膀胱外翻的疗效。方法:对13例膀胱外翻合并尿道上裂的患者采用简化的一期修复术,下腹部腹壁缺损采用局部腹壁皮瓣修复,术后随访18月到15年不等。结果:13例手术均顺利完成,手术时间平均4 h(3.5-5 h);术后住院时间平均17 d(16-21 d)。出院时腹直肌皮瓣均完全覆盖耻骨上腹壁缺损,外观良好。13例患者中完全控尿3例,部分尿失禁8例,完全性尿失禁2例。术后尿道皮肤瘘1例,经修补后治愈;尿道狭窄2例,经多次扩张后治愈。10例男性患者术后阴茎外观短粗,无勃起功能障碍。所有患者均认为手术明显提高了生活质量。结论:简化的一期修复术是治疗膀胱外翻比较理想的手术方式。

Objective： To investigate the effect of the one-stage operation to repair bladder exstrophy. Methods： Thirteen cases of the bladder exstrophy were treated by the one-stage operation,meanwhile, the suprapubic defect was repaired by local skin flap. The outcomes of all cases were observed with a mean of 9 years 2 months （range 18 months to 15 years） of follow-up. Results： All surgeries were successful with a mean time of 4 hours （range 3.5 to 5 hours）. The mean postoperative hospital stay was 17 clays （range16 to 21days）. The skin flap covered on the suprapubic defects completely. Of the 13 cases, 3 had complete urinary continence, 8 had partial urinary incontinence and 2 had urinary incontinence. Postoperatively, there was one case with urethrocutaneous fistula cured by local repair and two cases with urethral stricture cured by urethral soundings. The male patients＇ penises presented tubbiness appearance, but had normal function of erection. All patients conceded that the quality of life improved obviously after operation. Conclusion： It is a suitable way to repair bladder extrophy by the one-stage operation.