尿道下裂术后严重并发症的治疗体会

Management of complications after hypospadias repair

目的 探讨尿道下裂术后严重并发症的处理途径。方法 收治尿道下裂术后严重并发症１３ 例，分别采用三种不同的处理方法：①简单尿瘘修补和／或尿道狭窄处切除吻合２ 例；②彻底切除阴茎腹侧瘢痕组织和病变尿道，充分矫正阴茎下曲后同时重建尿道４ 例；③彻底切除阴茎腹侧病变组织，充分伸直阴茎、尿道后移造口，二期重建尿道７ 例。结果 方法①术后２ 例均失败，方法②术后１ 例并发尿瘘，半年后修补成功，方法③除２ 例尚未接受二期手术外，其他５ 例术后无尿瘘及尿道狭窄，效果满意。结论 治疗尿道下裂术后严重并发症应彻底切除阴茎腹侧瘢痕组织和全部病变尿道，充分伸直阴茎后同期或二期再作尿道成形术。

Objective To evaluate the management of complications after hypospadias repair.Methods Thirteen cases with hypospadias repair complication were reviewed. Three procedures were employed including:1) simple repair of urethral fistula and/or excision of urethral stricture (n=2), 2) scar excision, chordee release and one stage urethral reconstruction (n=4), 3) excision of scar tissue, release of chordee and secondary reconstruction of urethra (n=7). Results Procedure 1 resulted in failure in both cases. One patient who underwent procedure 2 developed urethral fistula, which was repaired 6 months later. Five of the 7 cases who underwent procedure 3 recovered satisfactory without any complication and the second- stage urethroplasty of the other 2 cases was not carried out yet. Conclusion The main point of the treatment for hypospadias repair complication is adequate excision of scar tissues and chordee release with one or second stage urethroplasty.