尿道下裂术后复发尿瘘的影响因素及处理

Influence Factor and Management of Recurrent Urethrocutaneous Fistulas after Hypospadias Surgery

目的:探讨尿道下裂术后再发尿瘘的各项相关因素在尿瘘修复的影响。方法:回顾性总结1997年1月～2008年6月收治的106例尿道下裂术后复发尿瘘患者临床资料。统计并分析尿瘘位置、瘘口大小、瘘口数目、尿瘘修补次数等相关观察指标,采用合适的术式进行尿瘘修补。结果:84例一次修复完成,一次手术成功率79.2%;22例再次出现尿瘘,其中1例同时并发尿道狭窄,需进一步治疗。不同的尿瘘位置与手术成功率差异无统计学意义(P>0.05),瘘口的大小、数目不影响手术成功率(P>0.05),术前修补的次数与手术成功率差异无统计学意义(P>0.05)。结论:尿瘘的位置、大小、数目和手术修补次数等因素不影响手术成功率。术前对患者的尿瘘位置、瘘口大小、瘘口数目及局部条件的不同需制定明确的方案。选择合适的术式及术中的精细操作是最重要的因素。

Objective：To evaluate the impact of fistula characteristics on the outcomes of repair in recurrent urethrocutaneous fistulas after hypospadias surgery. Methods：We reviewed the records of 106 patients with recurrent urethrocutaneous fistulas between 1.5 years and 26 years of age, who underwent surgery between January 1997 and June 2008. The prognostic significance of the site, size, number of fistulas, number of the previous op- erations, and the techniques applied were analyzed by the appropriate statistical methods as the parameters of the study. Reults：84 patients were cured postoperatively. The success rate of repair of fistula was 79. 2%. 22 patients developed fistulas, while 1 patients combined with urethi, al strictures postoperatively. No statistically significant relation was found between the fistula site and the success rate （P〉0. 05）. The fistula size and the number of fistula repairs, number of previous operations also did not affect the outcome （P〉0. 05）. Conclusions： The site, size, and number of the fistula repair seemed to have no impact on the success rate. Definite plan should be made according to the site, size, and number of the fistulas before operation. Choosing proper technique and meticulous surgical technique are important aspects for success.