解放军医学院学报2017，Vol.38Issue(11)：1055-1058,4.DOI:10.3969/j.issn.2095-5227.2017.11.015
儿童复杂近端型尿道下裂术后尿道狭窄的病理改变及治疗
Pathologic characteristics of urethral stricture after correction of complex proximal hypospadias in children and its treatment
肖元宏 1王政 1陈迪祥 1彭少林 1王宪强 1王振栋 1刘洲禄 2刘贵麟1
作者信息
- 1. 解放军总医院小儿外科,北京100853
- 2. 解放军总医院普通外科,北京100853
- 折叠
摘要
Abstract
Objective To study the pathologic characteristics of urethral stricture after correction of complex proximal hypospadias in children and its treatment.Methods Clinical data about 8 children who admitted to our department for their urethral stricture after operations of complex proximal hypospadias from October 2008 to June 2017 were analyzed retrospectively.Results The age of 8 children at first admission ranged from 2 years to 11 years,with a mean age of 4.85 years.All of them received flap tube urethroplasty as their primary procedures.Before primary operations,there were 4 cases with penile type hyposadias,one case with penoscrotal type and 3 cases with perineal type.The pathology of urethral stricture were classified as:type Ⅰ (2 cases):meatal stricture followed by fistula,type Ⅱ (2 cases):segmental stricture of urethra,type Ⅲ (2 cases):coexistence of meatal stricture,fistula and diverticulum,and type Ⅳ (2 cases):meatal stricture and urethral stricture followed by fistula and urethral dilatation.Patients with type Ⅰ stricture were cured by meatal dilation or Mathieu procedure of glan urethroplasty.Cases with type Ⅱ stricture were cured by end to end spongiosum urethral anastomosis or incision of the stricture and insertion of urethral tube.Cases with type Ⅲ stricture received two-stage repair,with primarily diverticulum excision,glan urethral plate palsty and fistula repair,and glan urethral plasty secondarily.Cases with type Ⅳ stricture also received two-stage repair,with primarily scared urethral ostomy and urethral tube insertion of the distal urethral for dilation,and secondary flap repair for the ostomy and glan urethral plasty after scar softened completely.Length of treatment for 6 cured patients ranged from 14 months to 62 months with a mean value of 30.17 months.Frequency for treatment ranged from 2 to 9 times with a mean value of 5 times.Conclusion Postoperative urethral stricture most commonly occurrs in children suffered from complex proximal hypospadias who have received flap tube as their primary urethroplasty.Longitudinal incision of the stricture loop or segmental stricture,followed by urethroplasty using ventral or dorsal penile skin flap with relatively good blood supply and flexibility to replace the unhealthy urethral are the appropriate option for cure.关键词
儿童/尿道下裂/术后尿道狭窄Key words
child/hypospadias/postoperative urethral stricture分类
医药卫生引用本文复制引用
肖元宏,王政,陈迪祥,彭少林,王宪强,王振栋,刘洲禄,刘贵麟..儿童复杂近端型尿道下裂术后尿道狭窄的病理改变及治疗[J].解放军医学院学报,2017,38(11):1055-1058,4.
