尿道下裂修复术后尿瘘成因剖析及其修补.docVIP

尿道下裂修复术后尿瘘成因剖析及其修补 　　[摘要]目的:研究先天性尿道下裂手术后尿瘘发生的原因,探讨手术治疗的方法。方法:回顾性分析我院近10年168例行尿道下裂修复术后发生的21例尿瘘的产生原因。采用“U”形皮瓣多层覆盖法进行修补。手术后适度加压包扎,采取措施保证尿液引流通畅。结果:尿道下裂手术后发生尿瘘的原因主要有:取材时血管蒂游离不当,致使皮瓣血液供应差;尿液引不通畅,致使缝合创面过早浸泡尿液导致感染;远端尿道狭窄,排尿时尿道内压力过高,致吻合口裂开;缝合材料质量差;技术不成熟。采用多层覆盖手术尿瘘修补后,该组有1例多发尿瘘术后再次发生细小尿瘘,其余全部治愈。结论:尿道下裂手术发生术后尿瘘的主要原因是取材时血管蒂供血不足和尿液转流不通畅。感染因素和修补器材也不可忽视,术者应选用自己熟悉的成熟术式进行尿道下裂修复术。采用“U”形皮瓣多层覆盖尿瘘修补术效果良好。尿道下裂手术后尿瘘修复手术中,修补成功的关键在于游离充足的血运良好的皮瓣、多层次的缝合和良好的术后尿转流。 　　[关键词]尿道下裂;尿瘘;皮瓣;修补 　　[中图分类号]R695[文献标识码]A[文章编号]1008-6455(2010)02-0167-03 　　 　　The causes and repair of urinary fistula postneoplasty 　　WU Xuan-lin,XU Quan,LI Peng,GUO Zheng-tuan,GUO Xin-kui,GONG Wei 　　ZHANG Ai-hui 　　(Department of Pediatric Surgery, The SecondAffiliatedHospital ofXian Jiaotong University, Xian 710004, Shaanxi, China) 　　 　　Abstract: ObjectiveTo study the cause of urinary fistula postneoplasty, and to explore the operative treatment.Methods We retrospectively analyzed 168 cases of hypospadias which had been treated with neoplasty in recent 10 years in our hospital, of which 21 cases urinary fistula occurred postoperation and then was treated with U-shaped skin flap multilayered overjet procedure.ResultsThe causes of urinary fistula postneoplasty were mainly associated with: improperly drew materials which might be with bad blood supply; impassable pathway of urine for by-pass which could lead to bad drainage of urine and soaked the sutured raw surface in the urine, and then infection occurred subsequently; distally stricture which might cause disruptive sutured raw surface because of high pressure intraurethral while urinating; the suture materials of poor quality; poor surgical technic. After operation for urinary fistula, all cases fully recovered except one case with multiple urinary fistulae to whom little urinary fistula happened again. Conclusion The main causes of urinary fistula postneoplasty are associated with skin flap of poor blood supply and impassable pathway for urine by-pass. Infection and s