摘要目的:总结女性尿道下裂患者的治疗经验。方法:回顾性分析2011年12月至2019年12月上海交通大学医学院附属第六人民医院收治的12例女性尿道下裂患者的临床资料。年龄(31.0±16.6)岁(7~67岁)。其中3例既往有骨盆骨折外伤史，3例有产伤史，余6例无外伤及手术史。12例中先天性尿道下裂6例，获得性尿道下裂6例。临床表现为尿失禁6例，排尿费力6例。查体：外阴部正常尿道外口位置未见尿道口，尿道口下移至阴道前壁的不同部位。所有患者均采用尿道延长术。对于先天性尿道下裂，术中采用尿道板裁剪卷管以延长尿道。对于获得性尿道下裂，采用阴唇带蒂皮瓣卷管扩大狭窄段尿道并予延长。游离大阴唇皮下脂肪垫并转移到新构建的尿道外侧，以防止尿道阴道瘘的发生并提高尿道压力。5例存在明显尿失禁的患者同时行膀胱颈部重建。解剖性修复成功定义为外观上可在阴蒂下方见到正常外形的尿道外口；功能性修复成功定义为患者术后无中、重度尿失禁出现；术后12个月随访，最大尿流率>15 ml/s。分析患者手术效果。结果:12例手术均顺利完成，均无围手术期并发症。术后随访(57.3±32.5)个月(18~96个月)。12例术后均能自发排尿；术前有尿失禁症状的6例中，术后4例尿失禁症状消失，2例明显改善；6例排尿费力者中术后4例排尿通畅，2例术后仍有排尿费力，后通过扩张尿道减轻症状。本组手术解剖性修复成功率为100.0%(12/12)，功能性修复成功率为83.3%(10/12)。结论:尿道延长术是治疗女性尿道下裂的有效方法，带蒂脂肪垫有助于增加尿道压力和防止瘘的发生；对于女性尿道下裂合并严重尿失禁患者，膀胱颈部重建是效果较好的一种术式。

abstractsObjective:To summarize the ideal strategy for the treatment of female hypospadias.Methods:The data of 12 female patients with hypospadias admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from December 2011 to December 2019 were retrospectively analyzed. The patients was (31.0±16.6) years old (7-67 years old). Among them, 3 cases had a history of pelvic fracture trauma, 3 cases had a history of birth trauma, and the remaining 6 cases had no history of trauma and surgery. Among them, there were 6 cases of congenital hypospadias and 6 cases of acquired hypospadias. The clinical manifestations were urinary incontinence in 6 cases and dysuria in 6 cases. Examination of the normal position of the external opening of the genital urethra did not show the opening of the urethra, but moved down to different parts of the anterior wall of the vagina. All patients underwent urethral lengthening. For congenital hypospadias, the urethral plate is used to cut the coiled tube during the operation to prolong the urethra. For acquired hypospadias, the stenotic urethra was enlarged and lengthened with a labial pedicled flap coil. The subcutaneous fat pad of the labia majora was mobilized and transferred to the outside of the newly constructed urethra to prevent the occurrence of urethro-vaginal fistula and increase the pressure of the urethra. Five patients with significant urinary incontinence underwent bladder neck reconstruction at the same time. Anatomical success of the procedure was defined as the appearance of a normal-shaped external urethral opening beneath the clitoris. Functional success was defined as the absence of moderate to severe urinary incontinence after surgery, and the maximum urinary flow rate was >15ml/s during the 12-month follow-up period.Results:All operations were successfully completed. All patients had no perioperative complications, and were followed up for 18-96 months, with an average of 57.3±32.5 months. All patients were able to urinate spontaneously after operation, 4 cases of urinary incontinence disappeared, and 2 cases improved significantly; 4 cases of patients with strenuous urination urinated smoothly. The remaining 2 cases still complained of dysuria after operation, which was solved by subsequent urethral dilatation. The anatomical repair success rate was 100.0%(12/12) and the functional success rate was 83.3% (10/12).Conclusions:Urethral lengthening is an effective method for female hypospadias. The pedicled fat pad helps to increase urethral pressure and prevent fistulas. For female patients with hypospadias and severe urinary incontinence, bladder neck reconstruction is an ideal method. of the technique.