尿道内切开对儿童尿道吻合术后尿道再狭窄的疗效分析

Visual Internal Urethrotomy for Urethral Stenosis Recurrence after Ureterourethrostomy: A Study in Children

目的分析尿道内切开对儿童尿道吻合术后尿道再狭窄的疗效。方法回顾性分析2002年12月—2012年12月郑州大学第一附属医院小儿泌尿外科经会阴尿道吻合术后尿道再狭窄的患儿26例,均行直视下行尿道内切开术（VIU）。收集患儿的病历资料（包括患儿尿道损伤的病因、尿道吻合术后再狭窄间隔时间、再狭窄长度）;观察VIU后的疗效（治愈标准：排尿时无明显排尿困难,没有再狭窄的临床证据）;计算VIU成功率（行2次及以内VIU治愈即为成功）;记录VIU后随访过程中并发症的发生情况。结果患儿车祸伤并伴有骨盆骨折致后尿道损伤16例,骑跨伤致后尿道损伤8例,尿道炎性狭窄2例。经会阴尿道吻合术后至再狭窄间隔时间为1.5~14.0个月,平均4.0个月,其中≤3个月者15例,〉3个月者11例。尿道吻合术后再狭窄长度〈0.5 cm 17例,0.5~1.2 cm 9例。26例患儿中有21例导丝能顺利通过狭窄区域,狭窄部位均位于尿道球部或膜部。行1次VIU治愈者16例,行2次VIU治愈者6例,行3次及以上VIU治愈者4例。患儿VIU后随访时间为30.0~112.0个月,平均62.0个月。VIU成功率为84.6%（22/26）。最终患儿均能线状排尿且无排尿困难症状,随访过程中均未见尿道憩室及尿道回缩。结论对于再狭窄长度1.0 cm,且导丝能顺利通过狭窄区域的尿道吻合术后再狭窄患儿,尿道内切开治疗再狭窄的成功率较高,疗效较好。

Objective To evaluate the curative effect of visual internal urethrotomy（ VIU） on urethral stenosis（ US）recurrence after ureterourethrostomy（ UU） in children. Methods Clinical data of 26 child patients with US recurrence after UU from December 2002 to December 2012 were analyzed retrospectively. All patients had VIU. Clinical data were collected（ including etiology,urethral anastomosis in children with urethral injury restenosis after the interval,restenosis length）; curative effect observation after VIU（ the cure standard： no significant difficulty urinating urination,no restenosis and clinical evidence）; VIU success rate calculated,complications recorded during follow- ups. Results Sixteen patients had traffic accident injuries combined with pelvic- fracture- caused posterior urethral injuries（ PUI）,8 had PUI caused by straddle injury,2 had urethral inflammatory stenosis. The interval time of US recurrence after UU was 1. 5- 14. 0 months,averagely 4. 0 months,thereinto the interval time was 3 months or fewer in 15 patients,more than 3 months in 11. The restenosis length was 0. 5 cm in 17 patients,0. 5- 1. 2 in 9. In 26 cases there were 21 cases of guide wire could smooth through stenosis areas,which were all located at bulbus urethrae or membranous part. Sixteen patients were cured after 1 VIU,6 cured after 2,4 cured after 3 or more. The follow- ups lasted 30. 0- 122. 0 months,averagely 62. 0 months. VIU success rate was 84. 6%（ 22 /26）. Finally,the patients were able to urinate linearly without dysuresia symptoms,or without urethral diverticulum,urthral retraction. Conclusion For the child patients in whom restenosis length is 1. 0 cm and guide wire can smooth through stenosis areas,VIU is of good effects with a high success rate.