女童陈旧性尿道外伤的治疗

The management of old urethral injury in young girls

目的 提高女童陈旧性尿道外伤的疗效。 方法 总结 44例女童尿道外伤病例资料。其中陈旧性 43例 ,尿道阴道瘘 40例 ,阴道闭锁积脓 2例 ,阴道结石 1例 ,膀胱结石 1例。 2 8例带膀胱造瘘 ,15例为尿失禁。平均年龄 8岁。手术分 3类 :尿道贯通 7例 ,其中 3例再经阴道修瘘 ;经阴道修瘘 1例 ;经耻骨联合切除入路修复尿道及瘘 35例。 结果 40例随访 6个月～ 16年 ,排尿正常 2 9例 ,发生不全尿失禁 11例。 结论 除短段病例可用尿道贯通及大女孩经阴道修瘘外 ,多需经耻骨入路、裁剪膀胱三角区瓣修复尿道狭窄及尿道阴道瘘。

Objective To evaluate the management of traumatic urethral stricture or obliteration complicated by urethro vaginal fistula in young girls. Methods There were 44 girls aged 2～17 years with a mean of 8 have been suffered from old urethral injuries except one being a fresh injury.40 cases (93%) have had urethro vaginal fistula,including 6 with stricture,3 with vaginal atresia (2 of them with pus accumualted in the vagina) and 1 with stone in the vagina.28 girls have had a retained cystostomy tube and 15 with complete urinary incontinence,9 of them had undergone operations more than twice elsewhere with failure.The lapse between injury and admission varied from 4 months to 7 years. 3 kinds of surgical managements have been undertaken:penetrating and dilatation of the obliterated urethra in 7,in 3 of them repair of the urethro vaginal fistula via the vaginal approach being performed,only urethro vaginal fistula repair via the vaginal aproach being needed in 1,reconstruction of the urethra and repair of the urethro vaginal fistula via the transpubic aproach in 35 (81%). Results Follow up study for 6 months to 16 years have been achieved in 40 (93%),29 of them (72%) with normal urination and 11 with mild urinary incontinence. Conclusions Simple penetration and dilatation of the stricture could be carried out in obliterated urethra of short segment and repair of the urethro vaginal fistula via the vaginal approach could be undertaken for big girls.Transpubic approach with Young Dees Leadbetter procedure remains the treatment of choice for repairing the complicated urethral stricture or/and obliteration associated with urethro vaginal fistula in young girls.