尿液转流在两种一期尿道下裂修复术中作用的比较

Urinary diversion in the one-stage hypospadias repair

目的通过对40例两种术式一期尿道下裂修复术的回顾性分析,比较尿液转流的作用。方法将40例分为尿液转流组和非尿液转流组两组进行比较。结果尿液转流组:阴囊纵隔皮瓣法有2倒(2/14例,14%)同时并发尿瘘和感染,阴茎腹侧皮肤岛状瓣法有1/11例(9%)同时发生尿瘘及感染,非尿液转流组中阴茎腹侧皮肤岛状瓣法有4例(50%)发生尿瘘,阴囊纵隔皮瓣法无一例并发感染和尿瘘。结论应用阴囊纵隔皮瓣一期再造尿道时可以不进行尿液转流,而在应用阴茎皮肤岛状瓣一期修复尿道下裂时,进行尿液转流有利于较小尿瘘的自行愈合及减少尿瘘的发生。

Objective To investigate whether the urinary diversion is helpful for healing of the neourethra.Methods Twenty-four cases that had received one-stage urethroplasty were divided into two groups and analyzed retrospectively.The urinary diversion was used in one group of 10 cases.In another group of 14 cases no urinary diversion was used.Results One case developed a fistula and wound infection in the urinary diversion group.In the no urinary diversion group,2 out of 5 cases treated with the penile ventrolateral island skin flap urethroplasty developed wound infection and fistulas;excellent results were achieved in all 4 cases treated with the scrotal septal vascular pedicle skin flap urethroplasty;2 cases devel- oped fistulas and one case had wound infection in the 5 cases treated with the transverse preputial island flap urethroplasty.Conclusion The urinary diversion was not to he used in one-stage urethroplasty using scrotal septal vascular pedicle skin flap.When the neourethra was reconstructed by the penile ventrolateral island skin flap or the transverse preputial island flap,urinary diversion is helpful for spontaneous healing of small fistulas and useful in reducing the incidence of fistulas.