尿道下裂术后尿道瘘的处理

Management of urethral fistula after hypospadias repair

为了探讨尿道下裂成形术后尿道瘘的处理，对我院1975～1995年收治的251例尿道下裂患者术后发生尿道瘘的情况进行分析，结果术后发生尿道瘘60例，发生率为23．9％，其中28例行尿道瘘修补术，直接修补术15例，成功6例，带蒂皮瓣转移术4例，成功2例，瘘孔周围皮瓣横形Y－V成形术7例，均获成功，另2例重新施行尿道成形术亦获成功。认为只有提高尿道成形术的成功率，才能从根本上减少尿道瘘的发生；如发生尿道瘘，则应以瘘孔周围皮瓣横形Y－V成形术为主。

For discussing the management of urethral fistula occurred after urethroplasty in hypospadias. From 1975~ 1995 60 cases (23. 9% ) of fistulae after urethroplasty in 251 hypospadias patients were analyzed. 28 patients with urethral fistulae were surgically repaired. The direct closure teclinique was carried out in 15 ceses with 6 successful cases. The pedicle island nap repair was used in 4 patients,2 patients success. The transverse Y-V advancement flap technique was adopted in 7 cases with success in all. 2 cases of fistulae were successfully treated with a second urethroplasty. We think the most important consideration of hypospadias repair is how to improve the technique of urethroplasty. The transverse Y-V advancement flap technique was easy to be carried out with a higher success rate.