尿道下裂术后尿道憩室样扩张的处理与预防

Treatment and prevention of urethral diverticulum after hypospadias repair

目的总结尿道下裂术后尿道憩室样扩张发生的原因,提出合理的治疗与预防措施。方法回顾分析2002年2月至2005年12月首诊治疗尿道下裂术后发生尿道憩室样扩张患儿的临床资料,包括Ⅰ期尿道成形术的方法,憩室样扩张的发生时间、临床表现、部位,憩室裁减术中所见等。结果首诊治疗尿道下裂866例,Duckett术式546例(含Duckett+Duplay术式98例)。Onlay术式210例,Snodgrass术式71例,尿道口前移、阴茎头成形39例。术后并发尿道憩室样扩张50例,均发生于Duckett(含Duckett+Duplay)术式术后。憩室裁剪尿道修复术后随诊6个月以上,2例术后并发尿道瘘,2例术后再次发生尿道憩室样扩张,1例术后尿道狭窄,余一次治愈。结论憩室裁剪、尿道修复是治疗尿道憩室样扩张的手术方法。Ⅰ期尿道成形术时避免尿道狭窄和裁减新尿道宽度适中可防止尿道下裂术后尿道憩室样扩张的发生。

Objective To study the etiology of urethral diverticulum after hypospadias repair and find a better and reasonable treatment for it. Methods The clinical data of 866 patients with urethral diverticula after hypospadias repair between 2002 and 2005 were retrospectively reviewed. The methods of primary hypospadias repairs, and the timing, symptoms, site and operative findings of u- rethral diverticula were analyzed. Results There were 866 patients who were treated as primary hypo spadias. The types of hypospadias repairs included Duckett 546（Duckett ＋ Duplay 98）, Onlay 211） and Snodgrass 71. Fifty patients complicated with urethral diverticulum after Duckett repair and underwent diverticulectomy and urethroplasty, were followed up at least 6 month. Forty-five cases cured and 2 developed fistulas, two developed diverticulum and one developed stricture. Conclusions Diverticulectomy and urethroplasty are the effective methods for urethral diverticulurm. Avoiding excessive tissue separation and urethral stenosis may reduce the development of urethral diverticulum.