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.
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备注/Memo
收稿日期:2018-09-10。
通讯作者:齐进春,Email:qjcbaby333@163.com