尿道下裂手术后并发症的防治

目的探讨预防尿道下裂术后尿瘘及尿道狭窄的有效方法。方法回顾近8年同一手术者治疗的各型尿道下裂患者69例,分析围手术期针对预防尿道下裂术后并发症所采取的多种措施的疗效。结果一次成功率88.4%(61/69),并发尿瘘4例(5.8%),3例瘘口在冠状沟水平,1例尿瘘部位在阴茎根部;并发尿道狭窄4例(5.8%),2例见于近端吻合口,2例在尿道外口。结论术前分离包皮阴茎头粘连,术中合理选择术式及再造材料,保护组织血供,阴茎头劈开成形,术后尿液转流及恰当的包扎,有利于预防局部感染和局灶性缺血坏死,从而有效地减少尿瘘和尿道狭窄的发生。

Prevention of urethral fistula and strictures resulted from urethroplasty for hypospadias

Objective To evaluate several effective methods for preventing postoperative urinary fistula and strictures.Methods From Jan. 1997 to Mar. 2005, a total of 69 cases were reviewed respectively, who were underwent various methods of repair performed by the same surgeon with one stage urethroplasty. The individual methods and procedures were separately analyzed.Results The overall successful rate of one stage hypospadias repair was 88.4%(61/69). The complications included urethral fistula(5.8%, 4/69),urethral strictures(5.8%,4/69).Conclusion To make the one stage urethroplasty successful, it is necessary to reduce the incidence of fistula and strictures.Our experience suggests that the adhesion between the glands and prepuce of penis should be separated before the operation. Some methods are helpful for preventing local infection and ischemic necrosis, such as choosing the appropriate procedure according to the various types of hypospadias, selecting tissue for urethra reconstruction, good blood supply of the flap, using meticulous technique, plastic operation of the gland with two wings procedure, postoperative suprapublic diversion, modified pack.