尿道下裂术后尿瘘的修复

Surgical treatment of hypospadias fistula

目的 提高尿道下裂术后尿瘘修复的成功率。 方法 报告５４ 例６９ 个瘘孔采用不同修补方法修复尿道下裂术后尿瘘的结果。 结果 采用结扎包埋法修补１５ 个小瘘孔，１０ 个一次修补成功；简单皮瓣转移法修补瘘孔１３ 个，成功８ 个；ＹＶ 皮瓣法修补１７ 个瘘孔，成功１５ 个；旋转皮瓣法修补瘘孔４ 个，成功３ 个；采用改良的Ｔｈｉｅｒｓｃｈ 二期尿道成形术修补直径１０ｍ ｍ 以上的瘘孔２０ 个，１７ 个一次修补成功；各种修补方法总成功率为７２ ．５ ％ 。 结论 尿瘘修复应根据瘘孔大小和局部条件选择不同的修补方法。

Objective To evaluate the methods of surgical closure of hypospadias fistula. Methods From 1989 to 1997,69 hypospadias fistulae in 54 patients were repaired with different methods.The delay between the primary hypospadias operation and the first attempt to repair the fistula was beyond 6 months.The method of repair was mainly chosen according to the size of the fistula.Small and medium sized fistulae were respectively closed by ligation and covering up of the fistula,by simple advancement flap,Y V advancement flap or a rotation flap.For a large fistula,a repair procedure similar to the Thiersch second stage urethroplasty was performed. Results There was an overall success rate of approximately 72.5%.The succees rates of the different procedures were:66.7% (10/15) for ligation and covering up of fistula,61.5%(8/13) for simple advancement flap,88.2%(15/17)for Y V advancement flap,75%(3/4) for rotation flap and 85%(17/20) for the improved Thiersch second stage urethroplasty. Conclusions It is necessary to choose the appropriate procedure according to the size of the fistula and the local condition around the fistula.