尿道下裂成形术后尿瘘修补35例临床研究

Repair of urethral fistula after urethroplasty for hypospadias:a retrospective study of 35 cases

目的:提高尿道下裂成形术后尿瘘的处理水平。方法:回顾性分析2001年11月～2017年11月我院收治的35例患者因行先天性尿道下裂修复术后尿瘘的临床资料,年龄3～26岁,平均12.3岁。依据患者尿瘘的位置、数量、大小等将尿瘘分为单纯性尿瘘和复杂性尿瘘。单纯性尿瘘:首次手术出现的<3mm单个瘘,未进行过尿瘘修补术,采用简单切开缝合法,进行瘘口单纯缝合术或荷包缝合术。复杂性尿瘘:>4mm的单个尿瘘、修补过的3mm或>2个瘘口,采用连续无张力缝合修补瘘口、带蒂翻转阴茎皮瓣进行尿道成形术。结果:14例单纯性尿瘘组1次手术成功率为100%(14/14),无明显并发症发生。21例复杂性尿瘘组第1次修补手术成功率为66.7%(14/21),第2次修补手术成功率为71.4%(5/7)。皮瓣坏死5例,无术后感染、伤口出血等并发症发生,2例第2次修补手术失败后失访。术后随访12～24个月,发生尿道狭窄10例,行尿道扩张2～8次,平均5.3次。结论:按照尿瘘的多少、大小、位置、周围组织情况选择不同的手术方法可以提高尿瘘修补成功率。

Objective:To improve the treatment level of urinary fistula after urethroplasty for hypospadias.Method:From 2001 to 2017,35 urethral fistula after urethroplasty for hypospadias were reviewed and the age ranged from 3 to 26 years old,with an average age of 12.3 years old.The delay between the primary hypospadias operation and the first attempt of fistula repair was more than 6 months.We have classified urinary fistula into two types:the simple urinary fistula and the complex urinary fistula according to the relevant literature.The pocket stitching and the Y-V skin flap technique were adopted in simple urinary fistula with a single urine fistula below3 mm.Continuous tension free suture and the pedicled inverted penile flap were used for urethroplasty to the complex urinary fistula with a single urinary fistula of more than 4 mm or a repaired fistula of 3 mm or more.Result:The success rates of the first r repair of the simple urinary fistula were 100%(14/14),but 66.7%(14/21)to the complex urinary fistula,respectively.The success rates of the second repair of the complex urinary fistula were71.4%(5/7).Skin flap necrosis occurred in 5 cases without postoperative infection,wound bleeding or other complications.Two cases missed follow-up after the failure of the second repair operation.Over the follow-up period of 12-24 months,urethral stricture occurred in 10 cases,and urethral dilatation was performed 2-8 times,with an average of 5.3 times.Conclusion:According to the principle and the individual situation such as different fistulas and surrounding skin,personalized operative methods may improve the success rate of the repair of urethral fistula after urethroplasty.