Jia Jianghua,Qi Jinchun,Du Lei,et al.Diagnosis and treatment of urethral stricture after hypospadias operations: a report of 69 cases[J].Journal of Clinical Pediatric Surgery,2019,18(06):514-517.[doi:10.3969/j.issn.1671-6353.2019.06.015]
69例尿道下裂术后尿道狭窄的治疗经验分析
- Title:
- Diagnosis and treatment of urethral stricture after hypospadias operations: a report of 69 cases
- Keywords:
- Hypospadia; Postoperative Complications; Urethral Stenosis/TH; Urethral Stenosis/SU; Treatment Outcome
- 分类号:
- R726.9;R699.6
- 摘要:
- 目的 通过观察尿道下裂术后尿道狭窄的不同治疗方法及效果，探讨最合适的治疗方案。方法 对2005-2016年69例尿道下裂手术后出现尿道狭窄患儿的临床资料进行回顾性分析。所有患儿随访6个月至11年，患儿发生尿道狭窄时，首先予以尿道扩张，最终以患儿排尿通畅、尿线粗、无尿道憩室为治愈标准（包括间隔时间 > 2个月行尿道扩张1次的轻度尿道狭窄患儿）。结果 69例尿道下裂术后出现尿道狭窄患儿中，22例经间断规律尿道扩张治愈（31.88%）；28例（40.58%）通过间断尿道扩张后缓解时间较短，经留置多孔硅胶软管支架治愈；13例（18.84%）采用尿道扩张及留置支架管后无改善行尿道狭窄切开，同期行尿道成形术，治愈8例，3例出现尿道狭窄，经尿道扩张治愈，2例出现尿道瘘，6个月后尿道瘘修补成功治愈；6例（8.7%）尿道探针无法通过，尿道扩张未成功，采用切除尿道瘢痕，一期预置尿道板，二期行尿道成形术，治愈4例，1例尿道瘘6个月后行尿道瘘修补术成功治愈，1例出现尿道狭窄，经尿道扩张治愈。结论 对于尿道下裂术后尿道狭窄的患儿，根据个体狭窄情况选择普通尿道扩张，或短时留置硅胶软管支架，可有效解决狭窄问题，临床效果肯定，有推广价值；尿道扩张失败的患儿应行尿道狭窄切除术，并同期或分期行尿道成形术。
- Abstract:
- Objective Through evaluating the effects of different methods for urethral stricture after hypospadias operation,we are trying to find the most suitable treatment for urethral stricture with different conditions. Methods Retrospective analysis was performed for 69 patients of urethral stricture after hypospadias surgery from 2005 to 2016.During a follow-up period of 0.5-11 years,urethral stricture was managed by urethral expansion.Curing was defined as voiding with a thick urinary stream and without urethral diverticulum.For mild urethral stricture,urethra expansion was performed at an interval of greater than 2 months.Results All of them underwent urethral dilatation initially.Twenty-two (31.88%) children were cured by intermittent urethral dilatation; 28 (40.58%) were relieved by indwelling porous silica gel hose bracket; 13 (18.84%) underwent urethral stricture incision plus urethroplasty and 8 became cured; 6 (8.7%) had urethral stricture resection plus second-stage urethroplasty and 4 were cured. Conclusion Intermittent urethral dilatation and indwelling porous silica gel hose bracketing are both effective and safe for patients with urethral stricture after hypospadias surgery.It is worthy of wider popularization.For difficult cases,urethroplasty is preferred.
参考文献/References:
1 王国录,刘智明,朱明挺,等.全程隧道式尿道下裂修复术10年经验总结[J].中华泌尿外科杂志,2015,36(6):470-471.DOI:10.3760/cma.j.issn.1000-6702.2015.06.020. Wang GL,Liu ZM,Zhu MT,et al.The whole tunnel type hypospadias repair 10 years experience[J].Chin J Urol,2015,36(6):470-471.DOI:10.3760/cma.j.issn.1000-6702.2015.06.020.
2 徐晔青,苏诚,莫家骢,等.尿道下裂中阴茎下曲的外科矫正[J].中华泌尿外科杂志,2012,33(5):386-389.DOI:10.3760/cma.j.issn.1000-6702.2012.05.016. Xu YQ,Su C,Mo JC,et al.Surgical diagnosis and correction of chordee among hypospadias[J].Chin J Urol,2012,33(5):386-389.DOI:10.3760/cma.j.issn.1000-6702.2012.05.016.
3 Ding J,Li Q,Li S,et al.Ten years’ experience for hypospadias repair:combined buccal mucosa graft and local flap for urethral reconstruction[J].Urologia internationalis,2014,93(4):454-459.DOI:10.1159/000360796.
4 Paulozzi LJ.International trends in rates of hypospadias and cryptorchidism[J].Environmental Health Perspectives,1999,107(4):297-302.
5 黄立渠,郭云飞,马耿,等.Onlay-tube-onlay 术式一期治疗重度尿道下裂的临床应用[J].中华泌尿外科杂志,2016,37(2):122-126.DOI:10.3760/cma.j.issn.1000-6702.2016.02.013. Huang LQ,Guo YF,Ma G,et al.Onlay-tube-onlay urethroplasty used for one-stage repairing of severe hypospadias[J].Chin J Urol,2016,37(2):122-126.DOI:10.3760/cma.j.issn.1000-6702.2016.02.013.
6 Li Y,Mao M,Dai L,et al.Time trends and geographic variations in the prevalence of hypospadias in China[J].Birth Defects Res A Clin Mol Teratol,2012,94(1):36-41.DOI:10.1002/bdra.22854.
7 文建国,冯全得.尿道下裂术后尿流率联合残余尿测定的意义[J].临床小儿外科杂志,2015,14(6):462-465.DOI:10.3969/j.issn.1671-6353.2015.06.003. Wen JG,Feng QD.Measuring significance of urinary flow rate and residual urine volume after hypospadias repairing[J].J Clin Ped Sur,2015,14(6):462-465.DOI:10.3969/i.issn.1671-6353.2015.06.003.
8 张小明,何恢绪,胡卫列,等.尿道下裂术后尿道狭窄的处理[J].中华泌尿外科杂志,2008,29(6):385-388.DOI:10.3321/j.issn:1000-6702.2008.06.006. Zhang XM,He HX,Hu WL,et al.Treatment of urethral stricture after hypospadias repairing[J].Chin J Urol,2008,29(6):385-388.DOI:10.3321/j.issn:1000-6702.2008.06.006.
9 唐耘熳.尿道下裂术后尿道狭窄、阴茎头裂开及尿道憩室的认识及处理[J].临床小儿外科杂志,2017,16(3):212-214.DOI:10.3969/j.issn.1671-6353.2017.03.002. Tang YM.Understanding and measures of urethral stricture,glan rupture and urethral diverticula after hypospadias repairing[J].J Clin Ped Sur,2017,16(3):212-214.DOI:10.3969/j.issn.1671-6353.2017.03.002.
10 韩刚,张朝华,黄研,等.2μm激光内切开术配合肾筋膜扩张器治疗小儿尿道下裂术后吻合口狭窄的效果[J].中国综合临床,2016,32(6):515-517.DOI:10.3760/cma.j.issn.1008-6315.2016.06.012. Han G,Zhang CH,Huang Y,et al.Efficacy of 2 μm continuous wave laser urethrotomy combined with renal sheath dilators for treatment of anastomotic stenosis after hypospadias repairments in pediatrics[J].Clinical Medicine of China,2016,32(6):515-517.DOI:10.3760/cma.j.issn.1008-6315.2016.06.012.
11 田军,张潍平,孙宁,等.延长留置导尿管在减少尿道下裂术后尿道狭窄中的作用[J].中华小儿外科杂志,2014,35(9):679-682.DOI:10.3760/cma.j.issn.0253-3006.2014.09.010. Tian J,Zhang WP,Sun N,et al.Prolonging indwelling catheter for reducing the occurrence of urethral strictures after hypospadias repair[J].J Clin Ped Sur,2014,35(9):679-682.DOI:10.3760/cma.j.issn.0253-3006.2014.09.010.
12 袁小莲,郑丽英.留置导尿护理研究进展[J].护理研究,2002,16(4):202-203.DOI:10.3969/j.issn.1009-6493.2002.04.009. Yuan XL,Zheng LY.Studying progress in nursing care of patients with indwelling catheterization[J].Chinese Nursing Research,2002,16(4):202-203.DOI:10.3969/j.issn.1009-6493.2002.04.009.
13 Shirazi M,Noorafshan A,Serhan A.Effects of different suture materials used for the repair of hypospadias:a stereological study in a rat model[J].Urol Int,2012,89(4):395-401.DOI:10.1159/000343423.
14 Yang SS,Chen SC,Hsieh CH,et al.Reoperative Snodgrass procedure[J].J Urol,2001,166(6):2342-2345.
相似文献/References:
[1]罗洪,孙德霞,强红家,等.不同部位皮肤再造尿道的病理学研究[J].临床小儿外科杂志,2010,9(06):443.
[2]丁勇,魏华,孔燕,等.横裁包皮岛状皮瓣法在尿道下裂治疗中的应用[J].临床小儿外科杂志,2010,9(06):474.
[3]景登攀张根领孙蔓丽.改良Snodgrass术治疗尿道下裂疗效观察[J].临床小儿外科杂志,2011,10(01):0.
[4]刘钢高昕刘树立黄柳明王伟邵培侯文英张军李龙.胆道闭锁葛西手术后肝内胆管扩张的治疗与预后分析[J].临床小儿外科杂志,2010,9(03):0.
LIU Gang,GAO Xin,LIU Shu-li,et al.The managements and prognosis of intrahepatic biliary dilatation with biliary atresia after Kasai procedure[J].Journal of Clinical Pediatric Surgery,2010,9(06):0.
[5]曹永胜,窦莹,蔡盈,等.改良Snodrass手术一期修复小儿尿道下裂25例[J].临床小儿外科杂志,2008,7(03):16.
[6]肖伟,高智勇.Snodgrass及Onlay island flap术式治疗小儿尿道下裂疗效对比分析[J].临床小儿外科杂志,2008,7(03):30.
[7]潘静,郑永钦,佘锦标,等.胆道闭锁术后肝内胆管囊性扩张的诊治[J].临床小儿外科杂志,2008,7(04):0.
[8]李志富 张泽俊 连松. 儿童手术后肠套叠29例分析[J].临床小儿外科杂志,2011,10(04):308.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):308.
[9]熊晶 刘颖 魏光辉 刘星 张德迎 吴盛德. HoxA13基因在尿道下裂胎鼠阴茎中的表达及意义[J].临床小儿外科杂志,2011,10(05):341.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):341.
[10]周维 李娟 黄国显 陈海琛 胡杨 徐延波. Snodgrass及Mathieu术式治疗前型尿道下裂的对比分析[J].临床小儿外科杂志,2011,10(05):364.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):364.
[11]郭慧杰,孙雪蕊,李守林,等.儿童尿道下裂TIP手术后近期尿流率变化研究[J].临床小儿外科杂志,2023,22(02):129.[doi:10.3760/cma.j.cn101785-202211059-006]
Guo Huijie,Sun Xuerui,Li Shoulin,et al.Variation tendency of urinary flow after tubularized incised plate urethroplasty in children with hypospadias[J].Journal of Clinical Pediatric Surgery,2023,22(06):129.[doi:10.3760/cma.j.cn101785-202211059-006]
[12]杨珍珍,李佳义,刘沛,等.一期Duckett与分期Bracka尿道成形术治疗非远端型尿道下裂术后并发症的Meta分析[J].临床小儿外科杂志,2023,22(02):168.[doi:10.3760/cma.j.cn101785-202202018-014]
Yang Zhenzhen,Li Jiayi,Liu Pei,et al.Efficacy of one-stage Duckett versus staged Bracka urethroplasty for nondistal hypospadias: a meta-analysis[J].Journal of Clinical Pediatric Surgery,2023,22(06):168.[doi:10.3760/cma.j.cn101785-202202018-014]
[13]周谦,张潍平,宋宏程,等.尿道板切开卷管尿道成形术治疗尿道下裂的近期疗效及术后尿道瘘相关危险因素分析[J].临床小儿外科杂志,2023,22(12):1139.[doi:10.3760/cma.j.cn101785-202202009-009]
Zhou Qian,Zhang Weiping,Song Hongcheng,et al.Analysis of risk factors for urethral fistula of hypospadias repair with tubularized incised plate urethroplasty[J].Journal of Clinical Pediatric Surgery,2023,22(06):1139.[doi:10.3760/cma.j.cn101785-202202009-009]
[14]杨志林,张培良,何盈颖,等.阴茎头宽度和尿道板宽度对尿道下裂TIP手术后并发症的影响分析[J].临床小儿外科杂志,2024,(06):555.[doi:10.3760/cma.j.cn101785-202209022-009]
Yang Zhilin,Zhang Peiliang,He Yingying,et al.Impacts of glanular width and urethral plate width on tubularized incised plate urethroplasty complications in children with hypospadias[J].Journal of Clinical Pediatric Surgery,2024,(06):555.[doi:10.3760/cma.j.cn101785-202209022-009]
备注/Memo
收稿日期:2018-09-10。
通讯作者:齐进春,Email:qjcbaby333@163.com