中国修复重建外科杂志

中国修复重建外科杂志

尿道下裂术后尿道狭窄的再手术方法及疗效分析

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目的 探讨尿道下裂术后尿道狭窄的再手术方法及疗效。 方法 2010 年 9 月—2018 年 4 月,对 169 例尿道下裂术后尿道狭窄经保守治疗无效患者行再手术处理。患者年龄 1 岁 7 个月~41 岁,中位年龄 5 岁 8 个月。尿道外口狭窄 80 例、吻合口狭窄 87 例、新建尿道部位狭窄 2 例。尿道下裂术后 2 周~52 个月出现尿道狭窄症状,中位时间 4.5 个月。尿道外口狭窄患者中,74 例行外口成形术,6 例行狭窄段切除尿道前移术;吻合口狭窄患者中,10 例行尿道镜下冷刀切开,26 例行狭窄段切除或切开并同期尿道重建,51 例行狭窄段造瘘、其中 43 例 12 个月后完成二期尿道重建;新建尿道部位狭窄患者行外瘢痕松解术。 结果 术后 154 例患者获随访,随访时间 6~86 个月,平均 47 个月。其中,137 例治疗后狭窄缓解;12 例狭窄复发,4 例出现尿瘘,均对症处理;1 例残留轻度尿道憩室未行手术处理。 结论 尿道下裂术后尿道狭窄,如经保守治疗无效,可根据狭窄位置、长度、局部组织条件以及合并症等情况选择合适术式治疗。

Objective To discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness. Methods Between September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation (74 cases) and urethral advancement (6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy (10 cases), urethrotomy and one-stage urethroplasty (26 cases), and urethrostomy (51 cases) including 43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis. Results One hundred and fifty-four patients were followed up 6–86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated. Conclusion If it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.

关键词: 尿道下裂; 尿道狭窄; 并发症; 手术

Key words: Hypospadias; urethral stricture; complication; surgical treatment

引用本文: 王学军, 唐耘熳, 毛宇, 覃道锐, 陈绍基. 尿道下裂术后尿道狭窄的再手术方法及疗效分析. 中国修复重建外科杂志, 2019, 33(2): 223-226. doi: 10.7507/1002-1892.201810057 复制

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