摘要目的 探讨不同方法治疗尿道下裂术后各型尿道皮肤瘘的效果.方法 回顾性分析2010年1月至2015年12月收治的101例尿道下裂术后尿道皮肤瘘患儿的临床资料.患儿年龄2岁5个月至14岁3个月,中位年龄5岁1个月.101例中单个瘘口86例(85％),2个瘘口13例(13％),3个瘘口2例(2％).101例患儿按以下方法分类处理:对于冠状沟及远端区域的瘘口,如瘘口离正常尿道开口很近且阴茎头翼融合处组织很薄为Ⅰ类,予尿道成形术;除Ⅰ类外的冠状沟瘘和阴茎体瘘,沿瘘口周围环形切开皮肤且游离瘘管,如瘘口与尿道相通处基底＜3 mm为Ⅱ类,予缝扎、结扎关闭瘘口;如瘘口与尿道相通处基底≥3 mm为Ⅲ类,予连续无张力缝合修复瘘口.修补后的尿瘘外层予去上皮的带蒂Dartos筋膜或游离的带蒂睾丸鞘膜覆盖.术后拔除导尿管后随访≥1年,未出现尿道狭窄、尿道裂开、尿道憩室、再次尿瘘定义为手术成功.结果 本研究101例共111个瘘口,其中Ⅰ类24个,Ⅱ类57个,Ⅲ类30个.101例术后随访1～4年,平均2.8年.1例术后出现尿道狭窄,予尿道扩张后排尿通畅;无尿道憩室和尿道裂开病例.13个瘘口出现再次尿道皮肤瘘,发生率为11.7％(13/111个),其中Ⅰ类4个(16.7％),Ⅱ类2个(3.5％),Ⅲ类7个(23.3％).结论 根据尿道下裂术后尿道皮肤瘘的部位和瘘口大小选择合适的方法进行分类治疗的效果更佳.术中对新尿道组织进行致密的覆盖非常必要.

abstractsObjective To investigate the proper procedure for repairing different urethrocutaneous fistulas after primary urethroplasty for hypospadias.Method There were 101 cases,whose age ranged from 27 months to 171 months (mean 61 months),underwent urethrocutaneous fistula repairing secondary to the primary hypospadiasis urethroplasty from January 2010 to December 2015.The methods of the repairing were chosen mainly on the site and the size of the fistula,which included three types.The coronal fistula with a thin band of tissue stretching between the glans wings was classified as type Ⅰ (n =24).For the rest of the small fistulas at penis coronal ditch and penis body,the small fistula (diameter ＜ 3 mm) was classified as type Ⅱ (n =57) and the large fistula (diameter ≥3 mm) was classified as type Ⅲ(n =30).The urethroplasty was performed in the type Ⅰ cases.The ligation and transfixion was performed in type lⅡ cases.And the tension free repairing with continuous suture was performed in type Ⅲ cases.De-epithelization dartos fascia flap or tunica vaginalis flap covering was performed in all cases.After removing the catheter,all cases were followed-up at least 1 year.The successive operation was termed as no complication,such as urethral stricture,urethral diverticulum and urethrocutaneous fistula.Result Totally 111 fistulas were repaired by the methods described above.The mean followed-up duration was 32 months (ranging 12-48months).Total recurrence of fistula was 11.7％ (13/111) in different type fistulas,including 16.7％(4/24) in type Ⅰ,3.5％ (2/57) in type Ⅱ and 23.3％ (7/30) in type 1Ⅲ.Conclusions Different classification and treatment of urethrocutaneous fistula after urethroplasty by the site and size of fistula can improve the outcome of the operation.It is necessary to cover the tissue tightly to a new urethra during the operation.