尿道下裂术后尿道扭曲误诊为尿道憩室样扩张的诊治体会

Experience of diagnosis and treatment of urethral distortion after hypospadias surgery misdiagnosed as urethra diverticulum-like dilatation

目的:通过尿道下裂术后尿道扭曲误诊为尿道憩室样扩张的病例分析,探讨尿道扭曲的诊断、治疗及预防。方法:回顾性分析2020年1月—2023年1月天津市儿童医院收治的尿道下裂术后尿道憩室样扩张的11例患儿的临床资料,包括患儿的身高、体重、合并畸形、前期手术信息和本次手术信息。患儿年龄2~6岁,其中7例术中证实为尿道扭曲,并非尿道憩室样扩张。结果:手术采用尿道与白膜间断缝合固定,尿道周围筋膜或Buck筋膜覆盖的方法。术后随访5个月~3年,7例尿道扭曲均痊愈,有2例出现尿道瘘,再次手术治愈。结论:尿道扭曲是尿道下裂尿道成形术后比较少见的并发症,临床易误诊为尿道憩室样扩张,再次手术固定尿道及尿道周围筋膜或BUCK筋膜覆盖是治疗尿道扭曲最为有效的方法。

Objective:The diagnosis,treatment,and prevention of urethral distortion were discussed through the analysis of cases misdiagnosed as urethra diverticulum-like dilatation after hypospadias surgery.Methods:The clinical data of 11children with urethra diverticulum-like dilatation after hypospadias surgery from January 2020to January 2023were retrospectively analyzed,including height,weight,combined malformations,information of previous operation,and information about the operation during this hospitalization.The patients ranged in age from 2to 6years,and 7of them had urethral distortion instead of urethra diverticulum-like dilatation.Results:The operation was performed by fixing the urethra and tunica albuginea through intermittent suture,and covering the periurethral fascia or Buck's fascia.After follow-up for 5months to 3years,all 7cases of urethral distortion were cured.Urethral fistula occurred in 2cases and was cured by re-operation.Conclusion:Urethral distortion is a rare complication after hypospadias urethroplasty,which is easily misdiagnosed as urethra diverticulum-like dilatation.Re-operation to fix the urethra and cover periurethral fascia or Buck's fascia is the most effective treatment for urethral distortion.