儿童外伤性后尿道狭窄或闭锁的手术治疗

目的　总结儿童外伤性后尿道狭窄或闭锁的手术治疗的体会。方法　后尿道损伤术后再狭窄或闭锁 38例患儿 ,其中经会阴尿道修复术 3例 ,经耻骨会阴联合尿道修复术 2 6例 ,经耻骨尿道修复术 4例 ,带蒂阴囊皮管代尿道 4例 ,经会阴和尾路尿道吻合及尿道直肠瘘修补术 1例。结果　38例患儿随访 1～ 8年 ,其中排尿正常者 34例 ( 89.5 % )。 1例经耻骨会阴联合尿道修复术尿失禁 ;2例经耻骨尿道修复术再次尿道狭窄 ;1例带蒂阴囊皮管代尿道术后排尿通畅 ,同时合并尿道会阴瘘。结论　①经耻骨会阴联合切口手术途径更适合于复杂性外伤性后尿道狭窄或闭锁的小儿 ;②顺行和逆行尿道造影时可能过多估计尿道狭窄的长度 ;③经会阴尾路联合途径对尿道直肠瘘修补失败者不失为一个好的选择     

尿道下裂术式选择与术后尿道狭窄发生的相互关系

分析尿道下裂尿道成形不同术式与术后尿道狭窄发生之间的关系。方法总结１９８７年６月至１９９７年６月本院治疗的４３４例尿道下裂尿道成形术资料,术后合并尿道狭窄５０例,分析不同术式,狭窄发生部位及狭窄发生率之间的关系。结果尿道口前移,龟头成形术（ＭＡＧＰＩ）、Ｏｎｌａｙｉｓｌａｎｄｆａｌｐ法（加盖岛状皮瓣诉狭窄率为０,Ｍａｔｈｉｅｕ法的狭窄率较低,为９．３％,而Ｄｅｎｎｉ－Ｂｒｏｗｎ与膀胱粘膜法的狭窄率     

Application of endoscopic Ho:YAG laser incision technique treating urethral strictures and urethral atresias in pediatric patients

Endoscopic holmium:yttrium–aluminum–garnet (Ho:YAG) laser incision is a new method applied in pediatric urology recent years. To evaluate its therapeutic efficacy on treating the pediatric patients with urethral strictures and urethral atresias, a retrospective study was performed from June 2001 to July 2005 in a total of 28 pediatric patients who underwent endoscopic internal urethrotomy using Ho:YAG laser in our center. In these patients, 25 had urethral strictures and 3 urethral atresias. Follow-up was done ranging from 2 months to 4 years to assess the treatment. Of the 28 patients, 25 (89.3%) have achieved satisfied result without complications following initial incisions. Two patients with urethral atresias and another with long lesion of stricture (> 2 cm) have postoperative stenosis (10.7%). Among the three reoccurred patients, two were successfully reoperated by Ho:YAG laser and open end-to-end anastomosis, respectively. One patient failed to follow-up. With the advantages of safety, efficacy and minimal invasion, endoscopic Ho:YAG laser incision technique could be used as a primary treatment in urethral stricture patients and is worthy to be popularized further in pediatric surgery.     

经会阴途径后尿道吻合术治疗小儿外伤性后尿道狭窄

目的　探讨会阴途径后尿道吻合术治疗小儿外伤性后尿道狭窄的适应证、手术原则、并发症。方法　经会阴途径后尿道吻合术治疗小儿外伤性后尿道狭窄或闭锁 35例。结果　随访 2 8例 ,随访率 80 .0 %。2 8例共治愈 2 1例 ,治愈率 75 .0 %。结论　经会阴途径尿道吻合术可作为开放手术治疗小儿外伤性后尿道狭窄的首选术式 ;彻底切除尿道周围瘢痕达到黏膜对黏膜无张力吻合是手术的关键 ;对后尿道狭窄闭锁段长者 ,加用长直针吻合法 ,可取满意的疗效。     

儿童复杂性尿道狭窄的治疗

目的 探讨儿童复杂性尿道狭窄手术方法的选择及成功的关键。方法 25例复杂性尿道狭窄采用不同的手术方法治疗30次，其中采用口腔粘膜管状重建尿道3例。口腔粘膜补片尿道成形3例；经耻骨径路尿道端端吻合11例，膀胱壁瓣尿道成形2例；经会阴径路尿道端端吻合8例；双阴唇带蒂皮瓣Ⅰ期尿道成形2例；带蒂包皮内板Ⅰ期尿道成形1例。结果 术后随访2-36个月。平均18.5个月。一次手术后排尿通畅20例。术后效果不佳5例。经再次手术后排尿通畅4例。结论 儿童尿道狭窄手术方法的选择应根据尿道狭窄段的长短，位置选择合适的术式；口腔粘膜具有取材方便。创伤小，有较强的抗感染力的优点，是一种较好的尿道替代物。     

Balanitis xerotica obliterans with urethral stricture after hypospadias repair

Three cases of urethral stricture due to balanitis xerotica obliterans (BXO) after hypospadias repair are reported. The first patient showed white, dense scarring on the prepuce before the hypospadias repair and developed a stricture of the urethra after the operation. The second and the third were uneventful for 6 and 2 years, respectively, after the hypospadias repair, and then developed urethral strictures. Pathologic diagnosis of the stenotic lesion is essential. Complete excision of the affected urethra with topical steroid ointment or sublesional triamcinolone injection is recommended for this condition. Although the complication of BXO after hypospadias repair is rare (3 out of 796 cases with hypospadias in our series), surgeons need to be aware of this condition as a cause for late onset of urethral problems. Accepted: 1 March 1999     

经输尿管镜钬激光碎石术治疗婴幼儿输尿管结石

目的 探讨经输尿管镜钬激光碎石术治疗婴幼儿输尿管结石的可行性和疗效.方法 回顾性分析2008年12月至2010年10月36例41侧婴幼儿输尿管结石采用经输尿管镜钬激光碎石术治疗的临床资料.结果 36例41侧输尿管结石,其中32侧一次入镜碎石成功;8侧采用导丝、输尿管导管、双J管扩张后碎石成功;1侧改经皮肾穿刺钬激光碎石术.所有病例术后均留置双J管1～4周,拔管后2周内复查B超或KUB结石全部排尽,清石率97.6％.7侧合并有输尿管息肉者,息肉切除.发生输尿管口撕裂1例,黏膜下假道2例,留置双J管4周,无输尿管反流和狭窄并发症.1例出现术后发热,经抗感染后体温正常.所有病例术后随访3～24个月未见输尿管狭窄和结石复发.结论 选择合适的输尿管镜,熟炼掌握操作技术,采用经输尿管肾镜钬激光碎石术治疗婴幼儿输尿管结石安全有效.     

尿道内切开术治疗男童外伤性尿道狭窄

目的　探讨应用尿道内窥镜下尿道内切开术 ,治疗男童外伤性后尿道瘢痕性狭窄的效果。方法　回顾性总结 2 1例陈旧性外伤性后尿道狭窄患儿 ,经尿道内切开术治疗的结果 ,分析手术方法、术中注意事项、手术成功率等。结果　 2 1例中 ,12例经 1次尿道内切开治愈 ,6例经 2次手术治愈 ,1例经 3次手术治愈 ,最终由尿道内切开术治愈 19例 ,成功率为 90 .5 % ,患儿排尿顺畅 ,尿流率正常。结论　经尿道镜下尿道内切开术治疗男童外伤性后尿道狭窄 ,是一种微创、简便、安全、有效的方法     

经耻骨会阴联合途径治疗男童复杂性后尿道狭窄或闭锁

目的：评价经耻骨会阴联合途径治疗男童复杂性后尿道狭窄或闭锁的临床疗效。方法：15例复杂性后尿道狭窄或闭锁的男童均行经耻骨会阴联合途径后尿道端端吻合术，其中3例合并尿道直肠瘘，结果：15例均一次手术成功，术后均能自主排尿，排尿通畅，10例术后最大尿流率（MFR）平均12．5ml/s，3例术后有尿失禁现象，其中2例6个月后尿失禁现象明显改善，11例随访6－36个月，排尿仍通畅，无需尿扩，步态平衡，结论：该术式适于尿道狭窄段较长或伴有尿道直肠瘘，假道等复杂性后尿道狭窄，尤其是以往经会阴途径后尿道修复手术失败者。     

Glanular diphallus with urethral stricture

 An unusual case of a 5-year-old boy with duplication of the glans, a rare variety of diphallia, is reported. The two glandes were arranged one above the other, the dorsal glans had only a blind pit while the ventral glans had a patent urethra with glanular hypospadias. The child also had right renal agenesis and a posterior urethral stricture. Accepted: 21 March 2001     

Management of urethral strictures in children

We report the results of a long-term follow-up study in 78 children with urethral strictures. The ages ranged from 1 month to 20 years and the follow-up from 8 months to 15 years (average 5.9 years). Balloon dilation was the primary treatment in 66 patients. Manipulative management (balloon dilation and endoscopic urethrotomy) was performed in 68 cases and was successful in 55. There were no complications. Balloon dilation alone provided an 80% success rate (53/66). Twenty-two patients were treated by one-stage urethroplasty, with an overall 95.5% success rate. The surgical repair was performed in 12 patients as a secondary procedure after failure of conservative treatment. Our data do not support the rather poor results usually reported in the pediatric literature associated with the balloon dilation technique.     

延长留置导尿管在减少尿道下裂术后尿道狭窄中的作用

目的 评价延长尿道下裂术后留置导尿管在减少尿道狭窄中的作用.方法 2011年2月至2012年2月采用管形包皮岛状皮瓣法治疗尿道下裂104例,年龄2～3岁,平均2.4岁.矫正阴茎下弯后成形尿道长度为3 cm,包皮岛状皮瓣的宽度为1.2 cm.术后第2天采用双盲法将患儿平均分为两组,A组术后6周拔除导尿管,B组术后2周拔除导尿管,比较两组拔管后尿道狭窄的发生情况.分别在术前和拔除导尿管后2周、4周和3个月测量患儿最大尿流率.结果 术后随访1～2年,平均1.5年.A组中术后出现尿瘘4例,B组6例.A组拔导尿管后2周和4周的最大尿流率分别为(11.3±3.4)ml/s和(10.8±2.5)ml/s,B组分别为(9.5±2.3)ml/s和(7.6±1.8)ml/s,两组比较差异均有统计学意义(P＜0.01).两组术前和拔导尿管后3个月最大尿流率比较差异均无统计学意义(P＞0.05).全部104例中有13例(12.5％)术后发生尿道狭窄.其中,A组术后有1例(1.9％)发生尿道狭窄;B组有12例(23.1％),两组比较,差异有统计学意义(P＜0.01).尿道狭窄发生时间为拔除导尿管后2～4周.A组术后出现尿道狭窄1例,再次留置导尿管4周后拔除导尿管未再发生尿道狭窄现象.B组术后出现尿道狭窄12例均行尿道扩张并留置导尿管,其中8例导尿管留置3～4周后拔除,未再出现尿道狭窄;4例于拔管后2～4周再次出现尿道狭窄,需再次留置导尿管3～4周.此4例拔除导尿管后,2例未再出现尿道狭窄现象,另2例在第3次拔除导尿管后4周和5周分别出现排尿困难现象,行狭窄段尿道劈开尿道造口术.结论 术后6周拔除导尿管与术后2周拔除导尿管比较,可有效地减少尿道狭窄的发生.术后最大尿流率检查可以帮助发现尿道狭窄现象的发生.     

尿道延伸术在小儿尿道外科中的应用

目的　探讨尿道延伸术在小儿尿道外科中的应用指征及疗效。方法　总结应用尿道延伸术治疗 87例患儿的疗效和随访情况。其病种有尿道下裂属冠状沟型 4 1例 ,远段阴茎体型 15例 ;阴茎下曲畸形 2 2例 (Ⅱ型者 7例 ,Ⅲ型者 15例 ) ;感染性尿道外口严重狭窄 3例 ;尿道下裂术后并外口狭窄及假性尿道憩室 6例。术中尿道延伸长度多数为 1.5～ 2 .8cm。 5例阴茎下曲矫直不满意行背侧白膜折叠横缝予以矫正。结果　术后 7～ 14d拔除导尿管 ,除 1例因感染致前移尿道退缩形成尿瘘外 ,其余排尿好 ,顺利出院。经随访 1～ 2年 ,5 6例尿道下裂中 ,4例有轻度外口狭窄 ,经 3～ 8次扩张治愈。 1例尿道瘘经修补治愈 ;6例尿道下裂术后者 ,2例又有狭窄 ,经 3～ 6个月扩张后治愈。 4例阴茎勃起时有 <10°的下曲 ,其中 2例行阴茎海绵体背侧白膜折叠横缝矫正。结论　尿道延伸术适应于尿道末段缺如或排尿障碍性疾病的治疗 ,小儿尿道延伸长度不宜超过 3.0cm。手术方法简单 ,成功率高     

输尿管镜钬激光治疗儿童输尿管末端囊肿的疗效分析

目的：探讨输尿管镜钬激光治疗儿童输尿管末端囊肿的疗效。方法回顾性分析2010年3月至2014年3月本院22例儿童输尿管末端囊肿临床资料,均经B 超、泌尿系CT、静脉尿路造影、膀胱逆行造影检查确诊,并接受输尿管镜钬激光囊肿切开术。22例患儿年龄3个月至15岁,平均3.6岁,其中女性15例（68.2％）,男性7例（31.8％）;左侧9例（40.9％）,右侧11例（50.0％）,双侧2例（9.1％）;囊肿开口于膀胱内20例（90.9％）,开口于膀胱颈尿道内口2例（9.1％）;16例（72.7％）合并患侧肾积水或者输尿管扩张,7例（31.8％）合并重复肾畸形,且均为上下位肾输尿管Y形融合并以末端囊肿开口于膀胱内,4例（18.2％）伴有膀胱输尿管反流,1例（4.5％）合并输尿管末端结石,13例（59.1％）合并尿路感染;均行输尿管镜钬激光囊肿切开术,手术时间为14～46 min,平均（28±10）min,术中出血量2～10 mL,住院时间2～5 d,平均（3.1±1.0）d。结果术后21例随访,1例失访,随访时间为3～31个月,20例未见输尿管囊肿复发,10例尿路感染症状完全消失,12例肾积水或者输尿管扩张得到明显改善,1例合并结石的未见复发,1例出现膀胱输尿管反流加重而行输尿管膀胱再植术。结论输尿管镜钬激光治疗儿童输尿管末端囊肿操作简便,创伤小,手术时间短,恢复快,并发症少,可作为首选治疗方式;对于严重膀胱输尿管反流,异位输尿管开口的重复肾患儿,术前需要做充分评估,以减少再次手术的风险。     

Congenital anterior urethral diverticulum in children

Congenital anterior urethral diverticulum (CAUD) is an uncommon condition in children usually presenting as a fluctuant ventral penile swelling. Retrospective data of nine patients with CAUD were analyzed. Patients presented with penile swelling (n=7), recurrent urinary tract infection (UTI) (n=5), and poor urinary stream (n=2). One patient who had gross pyuria was treated with initial marsupialization of the diverticulum and later underwent a definitive surgical procedure. One had deranged renal function, grade IV vesicourethral reflux (VUR), and UTI and was treated with initial urinary diversion followed later by excision of the diverticulum and urethral reconstruction. Of the seven patients who underwent primary repair of the diverticulum, all except one had a normal urethrogram on follow-up. One patient developed a stricture of the urethra that was treated with dilatations and is presently asymptomatic. In the two patients who had bilateral VUR, one grade III and the other grade IV, preoperatively, the reflux subsided and did not require antireflux surgery. Only one patient is on low-dose urinary antibiotic prophylaxis and presently has grade II reflux. Primary excision and repair is the preferred mode of treatment for CAUD. CAUD producing obstructive uropathy and VUR can be managed conservatively. In the presence of gross pyuria, marsupialization of the diverticulum followed by definitive surgery at a later date is safe and recommended. Accepted: 9 March 2000     

小儿胃石症的胃镜下钬激光碎石治疗

目的寻求小儿胃石症的有效治疗手段。方法采用钬激光对１２例胃石症患儿进行了胃镜下激光碎石治疗。结果胃石最大者为１２ｃｍ、最小者为２ｃｍ，经１～２次激光碎石治疗，全部患儿均获得治愈，未发生任何术中及术后并发症。结论胃镜下钬激光碎石术是目前治疗小儿胃石症的一种安全、有效的理想技术。