女童陈旧性尿道外伤的治疗

目的 提高女童陈旧性尿道外伤的疗效。方法 总结44例女童尿道外伤病例资料。其中陈旧性43例，尿道阴道瘘40例，阴道闭锁积脓2例，阴道结石1例，膀胱结石1例。28例带膀胱造瘘，15例为尿失禁。平均年龄8岁。手术分3类：尿道贯通7例，其中3例再经阴道修瘘；经阴道修瘘1例；经耻骨联合切除入路修复尿道及瘘35例。结果 40例随访6个月－16年，排尿正常29例，发生不全尿失禁11例。结论 除短段病例可用尿道贯通及大女孩阴道修瘘外，多需经耻骨入路、栽剪膀胱三角区瓣修复尿道狭窄及尿道阴道瘘。

The management of old urethral injury in young girls

Objective　To evaluate the management of tra umatic urethral stricture or obliteration complicated by urethro-vaginal fistul a in young girls.　Methods　There were 44 girls aged 2～17 years with a mean of 8 have been suffered from old urethral injuries except one being a fresh injury.40 cases (93%) have had urethro-vaginal fistula,including 6 wit h stricture,3 with vaginal atresia (2 of them with pus accumualted in the vagina ) and 1 with stone in the vagina.28 girls have had a retained cystostomy tube an d 15 with complete urinary incontinence,9 of them had undergone operations more than twice elsewhere with failure.The lapse between injury and admission varie d from 4 months to 7 years. 3 kinds of surgical managements have been undertaken :penetrating and dilatation of the obliterated urethra in 7,in 3 of them repair of the urethro-vaginal fistula via the vaginal approach being performed,only ur ethro-vaginal fistula repair via the vaginal aproach being needed in 1,reconstr uction of the urethra and repair of the urethro-vaginal fistula via the transpu bic aproach in 35 (81%).　Results　Follow up study for 6 m onths to 16 years have been achieved in 40 (93%),29 of them (72%) with normal ur ination and 11 with mild urinary incontinence.　Conclusions　Simple penetration and dilatation of the stricture could be carried out in ob literated urethra of short segment and repair of the urethro-vaginal fistula vi a the vaginal approach could be undertaken for big girls.Transpubic approach wit h Young-Dees-Leadbetter procedure remains the treatment of choice for repairin g the complicated urethral stricture or/and obliteration associated with urethro -vaginal fistula in young girls.