小儿尿道下裂术后尿瘘的成因及修复（附33例报告）

Children with urinary fistula after hypospadias： causes and re- pair （ report of 33 cases）

目的研究小儿先天性尿道下裂手术后尿瘘发生的原因，探讨小儿尿道下裂术后尿瘘的修复方法，总结手术经验，提高尿瘘一次修补成功率。方法收集2001年1月-2011年2月33例小儿尿道下裂尿道成形术后尿瘘的临床资料，平均年龄6．2岁（3～13岁）。共38个瘘口，瘘日直径小于3mm的有17个，瘘口直径为3—10min的有16个，大于10mm的有5个。分别采用结扎包埋法、Y—V皮瓣覆盖法、瘘口连续内翻缝合法、Thierseh法、Denis—Browne法及“u”形皮瓣多层覆盖法进行尿瘘修复，结果33例患儿一次修复成功30例，随访后排尿正常，阴茎外观满意，成功率为90．9％。结果小儿尿道下裂手术后发生尿瘘的原因主要有：取材时血管蒂游离不当，致使皮瓣血液供应差；尿液引不通畅，致使缝合创面过早浸泡尿液导致感染；远端尿道狭窄，排尿时尿道内压力过高，致吻合口裂开；缝合材料质量差；技术不成熟。结论小儿尿道下裂术后尿瘘的修复有多种术式，应根据尿瘘的部位、大小、数量和局部条件选择不同的手术方法。

Objective To study the causes of congenital hypospadias fistula and the repair methods, summarize surgical experience, and improve the success rate of fistula repair. Methods From January 2001 to February 2011, 33 cases of urinary fistula after hypospadias urethroplasty were collected, the average age being 6.2 years （3 to 13 years）. A total of 38 fistula were found, 17 with fistula diameter of less than 3 mm, 16 with fistula diameter of 3 -10 mm, 5 greater than 10 ram. Ligation embedding method were used, Y-V flap coverage method, a continuous inverted fistula suture, Tbiersch method, Denis-Browne method and the ＂U＂ shaped flap covering method were used for muhi-urinary fistula repair. Among the 33 cases, successful repair was found in 30 cases, with normal urination during flollow- up, good penile appearance, the success rate being 90.9%. Results The causes of bypospadias fistula after surgery in children are： vascularized free when properly drawn, resulting in poor blood supply to the flap; urine drainage was not smooth, resulting in premature suture wounds soaked in urine, causing infection; distal urethral stricture, high pressure within the urethra during urination, causing anastomotic dehiscence; suture materials of poor quality; technical immaturity. Conclusions The repair of urinary fistula after hypospadias in children has a variety of surgical procedures, choice of which should be based on fistula location, size, quantity and local conditions.