尿道下裂尿道成形术后尿瘘的处理

目的探讨尿道下裂尿道成形术后尿瘘的处理。方法总结1994-2003年464例尿道下裂尿道成形术后尿瘘治疗的临床经验。年龄1～18岁，平均6．5岁。2/3患儿来自外院。大尿瘘163例使用Thierseh、Snodgrass、Duckett、Duplay、Mathieu、Onlay、Denis—Browne和阴囊中隔修补术。小尿瘘301例用简单切开缝合法和Y-V皮瓣覆盖尿瘘修补法。结果术后随访6个月～10年，一次修补成功率93．3％，其巾大瘘85．9％，小瘘97．3％。结论尿道下裂Ⅰ期手术方法的正确选择对提高尿瘘修补手术成功率至关重要。应该按照尿瘘的大小、位置、数量和局部条件选择不同修瘘手术方法。

Management of Urethral Fistula after Hypospadias Repair

Objective To evaluate different surgical procedures for urethral fistula repair after hypospadias urethroplasty. Methods Four hundred and sixty-four post-hypospadia repair urethral fistula managed between 1994 to 2003 were reviewed. The delay between the primary hypospadias operation and the first attempt of fistula repair was more than 6 months. Urethroplasty was carried out for the 163 cases with large fistula. Of which there were 45 Thiersch repair, 30 Snodgrass, 26 Duekett,13 Duplay, 17 Mathieu, 6 Onlay, 11 Denis-Browne and 15 scrotal flap. The 3-layer closure technique and the Y-V skin flap technique were adopted in 301 cases with small fistula. Results The patients were followed up for 0. 5 to 10 years. Four hundred and forty- three repairs were successful after one attempt. The success rates of repair of large and small fistula were 85% and 97% respectively. Conclusions To have the best results of the urethral fistulae repair, it is essential to choose the right onestage surgical procedure for hypospadias repair. A urinary fistula repair should be performed by experienced pediatric urologist according to the location of meatus and the availability of skin.