尿道下裂术后尿道外口和吻合口狭窄的处理

Treatment of Urethral Strictures After Hypospadias Surgery

目的探讨尿道下裂术后尿道狭窄的预防和处理。方法对1992年6月～2002年6月收治的49例尿道下裂术后尿道狭窄的临床资料进行回顾性分析。结果49例中获访43例,其中尿道外口狭窄或闭锁行尿道外口成形12例(6例同时有吻合口狭窄),9例治愈;26例单纯吻合口狭窄行狭窄段剖开、切除吻合或Ⅰ期尿道重建,16例治愈;新尿道全部瘢痕狭窄行广泛切除Ⅰ期尿道重建3例,1例治愈;尿道造瘘Ⅱ期尿道重建,2例治愈;一次手术总治愈率65%(28/43)。结论尿道狭窄是尿道下裂术后的严重并发症,关键在于预防,选择适宜的手术方法,手术操作娴熟,减少术中出血,对合准确,及时清除尿道分泌物,使用生物反应小的缝线及导尿管是降低尿道狭窄发生的关键;早期发现,早期治疗。

Objective To study the prevention and management of urethral s trictures after hypospadias repair.Method From Jun.1992to Jun2002,we accepted148cases of complications after hypospadias surgery,49cases of ur ethrostenosis were retrospectively analyzed.Results43cases were followed-up .Of 12external orifice of urethra or atresia stenosis,including6cases with concomitant anastomotic strictures,were plastic operated with external orifice urethra,9cases of them were gained successfully;of26simple anastomotic str ictures,which underwent urethrotomy and one-staged urethal reconstruction, 16cases were cured;of3entire neourethral strictures,which underwent wide r anging dissection and one-staged urethroplasty,1case gained success;other2c ases,underwent urethrostomy and two-staged urethroplasty,were also cured.C onclusion s Urethral stricture after hypospadias surgery is a serious complicati on and it is difficult to treat.The key depend on prevention and should choose different method according to different conditions.