尿道成形术后并发尿瘘的治疗

目的探讨各种尿瘘的有效修复方法。方法对28例37个瘘口分别采用不同的修复方法,如瘘口贯穿结扎法、Thiersch偏心圆皮肤覆盖法、狭窄段尿道切除+尿道成形术等。结果采用贯穿结扎法9个瘘口中有1个复发;Thiersch偏心圆法修复17个瘘口有2个复发;伴发尿道狭窄、阴茎弯曲者6例11个瘘口,用转移皮瓣成形尿道,皮瓣全部成活,尿瘘无一复发。结论根据瘘口的大小和局部条件选择不同的修复方法,首先要切除瘢痕,造成新鲜创面,再以血运丰富的皮瓣修复瘘口。对伴有长段尿道狭窄和阴茎弯曲者,必须切除狭窄段尿道并以皮瓣成形尿道。

Treatment of Urethrocutaneous Fistula after Urethroplasty

Objective To evaluate the different types of surgical treatment for the urethrocutaneous fistulas after urethroplasty.Methods From 1995 to 2005,37 fistulas were occurred after urethroplasty in 28 patients.The fistulas were treated by through-through ligation,or Thiersch's eccentric skin grafts,or resection of urethral stricture followed by urethroplasty.Results Occurrence was observed in one fistula treated by ligation(1/9),and in two fistulas treated by Thiersch's eccentric skin grafts(2/17),but not observed in those when flaps were used to correct urethral strictures and cordee(11 fistula in 6 cases).Conclusions Different types of methods should be selected according to the size of fistula and surrounding condition around the fistula.The cicatricial tissue should excised and a flap is used to repair the defect when needed.