重度尿道下裂术后尿道狭窄的尿道扩张治疗

Urethral dilatation for urethral strictures after severe hypospadias repair

目的总结分析重度尿道下裂手术后尿道狭窄患儿尿道扩张治疗的经验。方法选择2010年1月至2015年6月南京医科大学第二附属医院重度(阴茎阴囊型、阴囊型和会阴型)尿道下裂患儿10例,年龄1.5~6.0岁,平均年龄3.0岁。回顾其手术治疗情况及手术后复查期间尿道扩张术治疗尿道狭窄情况,包括手术术式及分期,尿道扩张时间及过程,扩张后排尿情况。结果 10例患者均在术后1个月左右尿线开始变细时行尿道扩张治疗,其中6例可以顺利进行常规尿道扩张,扩张后排尿满意,间隔1个月进行再次扩张,术后3个月结束尿道扩张治疗进入常规随访,无排尿困难;4例患者常规尿道扩张困难转入全身麻醉下膀胱镜直视尿道扩张治疗,其中2例在9 F镜鞘下膀胱镜可顺利通过吻合口,随后常规扩张后置入10 F硅胶导尿管并留置,1周后拔管,另2例因9 F镜鞘下膀胱镜难以通过吻合口,故在监视下置入硬膜外麻醉导管入膀胱,随后在导管引导下置入8 F硅胶导尿管成功,留置1周后拔出,此4例患者均间隔1个月再次扩张,此后随访无明显排尿困难。结论对于难以常规尿道扩张的重度尿道下裂术后严重尿道狭窄患儿,膀胱镜技术是一个安全有效的辅助手段,可以提高成功率,降低盲目扩张造成尿道损伤和盲道发生的可能。

Objective To summarize the experiences of cystoscopic urethral dilatation in patients after severe hypospadias repair. Methods From January 2010 to June 2015, 10 children with severe type of hypospadias were enrolled, aged 1.5-6.0years old with mean age 3.0 years old. The data of operative procedures, urethral dilatation therapy after operation and outcome were reviewed. Results All the 10 patients accepted urethral dilatation therapy about 1 month after hypospadias repair operation, 6 cases were successfully performed dilatation again after 1-month, then 3-month ended regular treatment to follow-up, which without dysuria; 4 cases were performed cystoscopy urethral dilatation in general anesthesia because of the failure of regular methods, 2 cases passed anastomosis with 9 F cystoscopy, then conventional silica gel 10 F was implanted and indwelled, and extubated after 1-week. For 9 F cystoscopy was failed, the other 2 cases performed epidural anesthesia catheter into bladder, then silica gel 8 F implanted and indwelled, and extubated after 1-week. The 4 cases performed dilata-tion again after 1-month, and without dysuria occurred in follow-up. Conclusion It is demonstrated that in the patients with urethral stricture after severe hypospadias repair operation failed with the regular urethral dilatation, cystoscopic urethral dilatation is a simple, safe and effective method, which could improve success rate and avoid the urethral injury.