尿道修复术后尿道皮肤瘘的手术治疗：54例临床分析

Repair of urethrocutaneous fistulas secondary to urethroplasty： a retrospective study of 54 cases

目的 分析尿道皮肤瘘的大小、部位、数量与尿道皮肤瘘手术疗效的关系,探讨选择手术方式的参考依据,比较不同治疗方式的预后效果.方法 回顾性分析2003年1月至2011年7月收治的54例因行尿道下裂修复术（34例）或尿道狭窄成形术（20例）等尿道手术后尿道瘘的病例资料,根据瘘口大小、位置、数目以及是否伴有尿道狭窄等因素,分别采用单纯缝合术、推移邻近皮瓣修补术、带蒂翻转阴茎皮瓣尿道成形术、口腔黏膜代尿道成形术进行修补,分析治疗效果.结果 54例患者中,一次治愈46例,手术成功率约85％ （46/54）.6例经二次手术治愈;另有2例二期手术失败后失访.54例患者中,冠状沟处、阴茎部、阴茎阴囊交界处、阴囊及会阴部尿道瘘的手术成功率分别为100％ （6/6）、84％（26/31）、86％（6/7）、80％（8/10）;单个尿瘘及多个尿瘘的手术成功率分别为89％（40/45）、67％（6/9）;小型尿瘘及大型尿瘘的手术成功率分别为89％（39/44）、70％ （7/10）.结论 根据尿道皮肤瘘修复原则,针对不同情况的瘘道及周围皮肤,对每例患者采取个体化的手术方式来治疗尿道皮肤瘘,可减少患者的创伤,提高尿道瘘手术成功率.同时,用皮下组织及筋膜来构建中间防水层,能有效地降低尿道瘘修复手术的复发率.

Objective To investigate the correlation between the size,location,number of urethrocutaneous fistulas （UCF） and the effect of urethroplasty,and to study the reference in the choice of surgery methods of UCF and also to compare the prognosis of different treatment protocols.Methods Clinical data of 54 cases of UCF after urethroplasty of hypospadias and urethral stricture from 2003 to 2011 were collected.Simple suture,advancement skin flap,pedicle penile skin flap urethroplasty,oral mucosa urethroplasty were performed according to the size,location,number and whether there is urethral stricture of UCF.The effect of the operation was followed up and Chi-square analysis was used to analyze the data.Results The overall success rate of UCF repair was 85％ （46/54）,while there were 4 patients cured after second surgery,and there were 2 cases lost of follow-up after the failure of the second surgery.In all these patients,the success rate of UCF in the coronary sulcus,the penis,the junction of penis and scrotum,the perineum and the scrotum was 100％ （6/6）,84％ （26/31）,86％ （6/7） and 80％ （8/10）.The success rate of UCF of single fistula and several fistulas was 89％ （40/45） and 67％ （6/9）.The success rate of UCF of small fistula and large fistula was 89％ （39/44） and 70％ （7/10）.Conclusions According to the principle and the individual situation such as different fistulas and surrounding skin,personalized operative methods may improve the success rate of the repair of UCF.At the same time,there is a significant improvement in recurrence rates with the use of the interposition waterproofing layer of subcutaneous tissue and fascia.