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女童骨盆骨折后外伤性尿道狭窄或缺如的处理策略

Posttraumatic urethral stricture or loss secondary to pelvic fracture in girls: appropriate management

摘要:

目的 探讨女童骨盆骨折后外伤性尿道狭窄或缺如的治疗策略.方法 回顾性分析2009年1月至2015年12月采用不同术式治疗的20例骨盆骨折后外伤性尿道狭窄或缺如伴尿道阴道瘘女童的临床资料.年龄2~14岁,平均9.5岁;尿道狭窄或缺如段长2~4 cm,平均2.6 cm.20例中6例阴道远端严重狭窄或闭锁伴近端阴道严重积液.20例中10例采用带蒂阴唇或外阴皮瓣重建尿道,5例采用膀胱前壁瓣重建尿道,5例采用阴道壁瓣修复狭窄尿道;在尿道重建同时对6例伴有阴道远端严重狭窄或闭锁的患儿采用阴道壁瓣或外阴皮瓣重建远端阴道.结果 本组20例围手术期无严重并发症发生.术后随访12~70个月,平均41个月.尿道解剖修复成功率为90%(18/20),功能修复成功率为70%(14/20).10例采用带蒂阴唇皮瓣或外阴皮瓣重建尿道的患儿中2例手术失败,术后仍有尿道阴道瘘,2例有压力性尿失禁;5例采用膀胱壁瓣重建尿道的患儿术后排尿通畅,其中2例有压力性尿失禁;5例采用阴道壁瓣重建尿道的患儿全部修复成功并能控尿.6例伴阴道远端狭窄、近端积液的患儿术后积液消失.结论 女童外伤性尿道狭窄合并尿道阴道瘘的治疗术式应根据患者尿道病变的严重程度和阴道条件选用不同的技术.利用阴道近端扩大的囊壁同时重建远端尿道和阴道是治疗尿道狭窄合并阴道狭窄的一种较好的方法.

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abstracts:

Objective To explore the appropriate management for girls with posttraumatic urethral stricture or loss secondary to pelvic fracture.Methods Between January 2009 and December 2015,a total of 20 girls,mean age of 9.5 years (range 2-14 years),whose posttraumatic urethral stricture associated with urethrovaginal fistula were treated using a variety of procedures.The mean urethral stricture or loss length was 2.6 cm (range 2-4 cm).Six patients presented with vaginal distal stricture and associated with a large hydrocolpos in the proximal vagina.Of the 20 girls,urethroplasty was performed using labial pedicle flap or vulvar flap in l0 patients,using a bladder flap tube in 5 girls with total urethral loss,using vaginal flap in 5 cases.Colpoplasty using island vulvar skin flaps or hydrocolpos vagina were performed in the 6 patients associated with vaginal stricture during urethroplasty.Results There were no serious complications postoperatively.The mean follow-up period was 41 months (range 12-70 months) postoperatively.The overall anatomical success rate was 90% (18/20) and the functional success rate was 70% (14 / 20).Of 10 patients underwent pedicle labial or an island flap of vulva urethroplasty,2 patients were recurrent,and 2 patients present stress incontinence.Five patients underwent urethral reconstruction using a bladder flap tube and voiding well postoperatively,of which stress incontinence appeared in 2.All 5 patients who underwent vaginal flap urethroplasty could void normally and continently.The hydrocolpos disappeared in all 6 patients with vaginal distal severe stricture.Conclusions A differential surgical repair strategy should be determined by fistula location,stricture length and vaginal condition for posttraumatic urethral stricture associated with urethrovaginal fistula in girls.It is probably good choice to reconstruct distal urethra and vagina using a large hydrocolpos in the proximal vagina for the treatment of coexisting strictures of urethra and vagina.

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