应用显微外科技术修补尿道皮肤瘘

目的 报道应用显微外科技术采用不同手术方法修复尿道瘘的治疗效果。方法 二种术式修复尿道皮肤瘘25例，共28个瘘口，一是采用三层内翻间断缝合法治疗；二是采用去表皮阴囊隔皮瓣法修复。结果 显微外科修复一次成功率92％，1例延期愈合。结论 采用显微外科技术和最佳手术方法，修复尿道皮肤瘘，是手术成功的关键。     

用显微外科技术矫治尿道下裂

１９８６年至１９９３年，按照Ｔｈｉｅｒｓｃｈ法为８３例患者施行尿道成形术。其中６４例采用显微外科技术，１９例用传统的方法。结果显微外科组，一次手术成功率达８９．１％，术后发生局部感染８例，尿瘘４例，尿道狭窄３例。而传统方法组，一次手术成功率仅为４８％，术后发生局部感染８例，尿瘘８例，尿道狭窄１例。显微外科技术明显提高了手术成功率，可能与以下因素有关，显微外科技术操作精细，局部损伤小，成形尿道缝合准确，缝合时可不穿透皮肤，血运好，组织愈合好。此外，埋藏皮管的表面，皮肤、皮下组织分四层交错重叠缝合，可阻止尿道内分泌物的外渗，降低感染的发生率。     

显微外科技术修复尿道下裂术后尿瘘

目的探讨显微外科技术在修复尿道下裂术后尿瘘治疗中的作用，以提高尿瘘修复成功率。方法1999年7月至2006年5月，对33例尿道下裂术后尿瘘的44个瘘口，应用显微外科技术，分别采用Thiersch偏心圆皮肤覆盖法修复28例；对伴发尿道狭窄、阴茎弯曲者5例，行阴茎瘢痕组织及狭窄尿道切除，以阴囊皮瓣重建尿道，阴茎皮瓣覆盖尿道。结果Thiersch法修复33个瘘口有5个复发；部分尿道切除加阴囊皮瓣尿道成形术修复5例，共11个瘘口，皮瓣全部成活，尿瘘无复发。结论应用显微外科技术可提高尿瘘修复的成功率，尿瘘修复的成功率还与瘘口局部情况、术式选择等有关。     

瘘孔环扎加微型皮瓣法治疗尿道瘘

尿道下裂尿道重建术后易发生尿道瘘孔，采用显微外科手术行瘘孔环扎加微型重迭皮瓣方法修补２１例２８个瘘孔，均一次修补成功。本文治疗尿道瘘的优点，用皮 瓣修补使缝合缘无张力；环扎后封闭了瘘孔间隙；应用显微外科技术减少了组织创伤，这些均有利于组织愈合，使瘘孔顺利修复。     

尿道下裂术后尿道瘘的手术治疗

目的:探讨先天性尿道下裂术后阴茎部尿道瘘的发生原固和防治方法.方法:采用痿口周围皮瓣行Y-V成形法修补尿道瘘.结果:本组40例,手术一次成功31例,二次手术成功7例,超过3次手术2例,均为复杂性尿瘘.结论:尿道瘘口周围皮瓣Y-V成形法修补尿道瘘,成功率高,操作简便,值得临床推广.     

应用显微外科技术修复尿道下裂术后复杂性尿瘘

目的 探讨应用显微外科技术修复尿道下裂术后复杂性尿瘘的临床效果.方法 应用显微外科技术分别采用皮肤黏膜预植法、横向旋转皮瓣覆盖法对尿道下裂行尿道成形术后形成的复杂性尿瘘进行修复56例.结果 术后随访6个月～1年,修复56例,一次手术成功48例(成功率85.7%),5例延期愈合,1例因感染再次出现尿瘘并再次手术治愈,2例因旋转皮瓣坏死行二次手术治愈.结论 应用显微外科技术修复治疗尿瘘,对组织损伤小,一次手术成功率高,是治疗复杂性尿瘘较理想的方法.     

尿道下裂尿道成形术后并发尿瘘的治疗体会

目的:总结尿道下裂尿道成形术后并发尿瘘的治疗经验。方法:自1995年以来我院收治尿道下裂修复后并发尿瘘26例,其中8例并有尿道狭窄。大瘘(>0.3cm)12例,小瘘(<0.3cm)14例。大瘘口采用Thiersch偏心圆皮肤覆盖法,小瘘口用结扎法、简单切开缝合法、“Y-V”皮瓣覆盖尿瘘修补法。在修复尿瘘前先解决尿道狭窄。结果:一次修复成功22例(84.6％)。结论:尿瘘修复前首先解决尿道狭窄,对于大尿瘘应用连续内翻缝合及选用合成可吸收缝线等可提高修补成功率。     

显微外科技术在复杂性尿道狭窄手术中的应用

目的 探讨应用显微外科技术治疗复杂性尿道狭窄的手术效果. 方法 本院1997年6月-2011年3月采用显微外科技术施行阴囊后动脉为蒂的阴囊皮瓣尿道成形术治疗复杂性尿道狭窄86例.术中裁剪所需的带血管蒂的阴囊皮瓣,用16 - 18 F硅胶尿管作支架,围绕尿管形成带蒂的皮管,在手术显微镜下以5-0无创伤缝针间断缝合,并于尿道吻合,术后1个月拔出尿管. 结果 临床治疗86例,83例一次手术成功,术后排尿通畅,术后6个月,尿流率测定17.0～26.5 ml/s,成功率96.5％.其中2例术后1年并发尿道内毛发结石,结石发生率2.3％.术后发生尿瘘3例,发生率3.5％. 结论 应用显微外科技术施行阴囊后动脉为蒂的阴囊皮瓣尿道成形术对复杂性尿道狭窄进行修复,手术成功率高,尿道狭窄、尿瘘等术后并发症低,可获得良好的临床效果.     

整形外科学原则在尿瘘修复中的应用

目的 提高尿瘘修复手术成功率。方法 采用指钩、旋转和嵌入等三维缝合法进行尿瘘修复93例（131处瘘口）作为研究组，其中一期尿道成形患者52例，按瘘口位置分为冠状沟型19例，阴茎型17例，阴茎阴囊交界型12例，会阴型4例；因尿道再造材料不足和尿道废用需分期行尿道吻合者41例，瘘14均位于阴茎阴囊交界部位。对照组为1996年1月至2000年1月应用间断缝合法修复尿瘘患者85例。冠状沟型23例，阴茎体型19例，阴茎阴囊交界型33例。会阴型lO例，瘘口共98处。2组患者均应用局部筋膜和皮瓣组织进行修复。术后观察患者排尿时尿线、排尿通畅情况及有无尿瘘发生。应用尿道镜对修复尿道进行观察；尿瘘修复成功标准为排尿通畅，无尿瘘及尿道狭窄发生。结果 研究组瘘口一次修复成功率87．7％（115／131），复发瘘经换药自行愈合率56．3％（9／16），总愈合率94．6％（124／131）；对照组分别为75．5％（74／98）、25．O％（6／24）、81．6％（80／98）。尿道镜观察见尿瘘修补处无狭窄，壁光滑，缝线已脱落。结论 尿瘘手术操作应遵循整形外科学原则，旋转与嵌入缝合法符合组织移植成活规律，可提高尿瘘修复成功率。     

瘘孔环扎加微型皮瓣法治疗尿道瘘

尿道下裂尿道重建术后易发生尿道瘘孔，采用显微外科技术行瘘孔环扎加微型重迭皮瓣方法修补２１例２８个瘘孔，均一次修补成功。本法治疗尿道瘘的优点：用皮瓣修补使缝合缘无张力；环扎后封闭了瘘孔间隙；应用显微外科技术减少了组织创伤；这些均有利于组织愈合，使瘘孔顺利修复     

Urethrocutaneous fistula repair after hypospadias surgery

OBJECTIVE: To evaluate and compare the success rates of simple and layered repairs of urethrocutaneous fistulae after hypospadias repair. PATIENTS AND METHODS: The charts of 72 children who developed fistulae after hypospadias repair were reviewed; 39 had a simple closure of the fistula, whereas 32 had a 'pants over vest' repair, in all cases after excluding an impairment of urine outflow. RESULTS: The success rate at the first attempt was 74% for simple closure and 94% for the layered repair; at the second attempt it was 80% and 100%, the difference being statistically significant for both repairs. CONCLUSIONS: Although probably far from an optimal technique for repairing urethrocutaneous fistulae, the pants-over-vest repair allows a good success rate for penile shaft fistulae.     

Management of urethrocutaneous fistula after hypospadias repair: 10 years' experience.

OBJECTIVES: To report the outcome of managing urethrocutaneous fistula after hypospadias repair over 10 years. PATIENTS AND METHODS: Forty-seven patients (mean age 7.6 years, range 2-18) underwent repair of 57 urethrocutaneous fistulae after hypospadias surgery. The fistula was single in 37 patients and multiple in 10; 42 fistulae were small (< 4 mm) and 15 large (> 4 mm). Twenty-one fistulae were at the corona, 15 at the anterior shaft, 16 at the mid-shaft and five were penoscrotal. The interval between primary hypospadias repair and the first attempt at fistula repair was 6-12 months. Small fistulae were repaired using a multilayer simple closure technique, and large fistulae repaired using rotational and advancement skin flaps. Suprapubic urinary diversion was used in all patients with large fistulae or small multiple fistulae (25 patients); an overnight urethral catheter was used in the remaining patients. RESULTS: Simple closure was successful in 30 of 42 small fistulae (71%); eight were successfully closed by secondary closure, while four needed a third closure. Rotational and advancement skin flaps were successful in 13 of 15 large fistulae; one required secondary flap repair and one was closed simply. Most recurrences (78%) were of coronal fistulae; there was recurrence in four of 25 (16%) patients in whom suprapubic diversion was used, in contrast to 10 of 22 (45%) with no suprapubic diversion. CONCLUSIONS: Although simple closure of a fistula is easy and not time-consuming it is followed by a significantly higher rate of recurrence than when skin flaps are used. Rotational and advancement flaps are the optimal methods for repairing fistulae after hypospadias, particularly for large and coronal fistulae. Thus, the appropriate indication for simple closure is small fistulae at the penile shaft. Suprapubic diversion is important in those with large or multiple fistulae.     

尿道下裂术后尿道瘘的处理

为了探讨尿道下裂成形术后尿道瘘的处理，对我院1975～1995年收治的251例尿道下裂患者术后发生尿道瘘的情况进行分析，结果术后发生尿道瘘60例，发生率为23．9％，其中28例行尿道瘘修补术，直接修补术15例，成功6例，带蒂皮瓣转移术4例，成功2例，瘘孔周围皮瓣横形Y－V成形术7例，均获成功，另2例重新施行尿道成形术亦获成功。认为只有提高尿道成形术的成功率，才能从根本上减少尿道瘘的发生；如发生尿道瘘，则应以瘘孔周围皮瓣横形Y－V成形术为主。     

Outcome of hypospadias fistula repair

Objectives To examine the long-term results of hypospadias fistula repair, the factors involved in recurrence and the outcome in cases where this has occurred. Patients and methods The study comprised 113 children undergoing urethrocutaneous fistula repair between 1984 and 1996. Most of the fistulae were closed in two to three layers, with or without a transpositional skin flap. Tunica vaginalis or a scrotal dartos flap was used in patients with inadequate vascularized tissue adjacent to the fistula. Success rates were calculated for each attempt at fistula repair until the patient was cured. Results The median (range) age at primary fistula repair was 40 (18-169) months and the median follow-up after the most recent repair 7.5 (2.3-17) years. The overall success rate of primary fistula repair was 71%. Fistulae which were >2 mm (11 of 21, 52%) were more likely to recur than were those < or = 2 mm (22 of 92, 24%). Recurrence did not relate to the initial form of hypospadias repair, to the means of skin closure nor, with the exception of multiple lesions, to the location of the fistula. The success rates of subsequent repairs were 70% at the second and 50% at the third, fourth and fifth repairs. One child was cured at the sixth attempt. The use of tunica vaginalis or scrotal dartos as a 'waterproofing' layer was limited to the third or subsequent repairs and was successful in five of six cases. Conclusion A simple layered closure with or with no transpositional skin flap is effective in 71% of repairs. For recurrent fistulae, tissues from an unscarred area (tunica vaginalis or scrotal dartos layer) should be used to cover the fistula.     

女性尿路生殖道瘘诊疗分析(附27例报告)

目的:总结女性尿路生殖道瘘临床诊疗经验,探讨复杂性女性尿路生殖道瘘的治疗方法。方法:本组27例,年龄16~56岁,平均41.2岁。其中膀胱阴道瘘9例,输尿管阴道瘘15例,输尿管子宫瘘1例,尿道阴道瘘2例。妇科盆腔手术所致23例,会阴部或盆腔外伤所致3例,放疗所致1例。9例膀胱阴道瘘中,3例行耻骨上经膀胱修补,2例经阴道修补,3例复杂性瘘经腹修补并移植带蒂大网膜,1例放疗后复杂性瘘行输尿管皮肤造口术。15例输尿管阴道瘘中,6例行输尿管镜下输尿管双J管留置术,9例行输尿管膀胱再植术。1例输尿管子宫瘘行耻骨上辅助经脐单孔腹腔镜(SA-LESS)输尿管膀胱再植术。2例尿道阴道瘘均经阴道行修补术,其中1例采用改进三层错位缝合术修补。结果:24例一次治愈,成功率为88.89%(24/27);3例二次手术治愈。平均手术时间75(45~135)min,平均术中出血量60(15~150)ml。术后随访4个月~13年,27例患者均未再出现漏尿,无尿失禁、尿道及阴道狭窄,无继发性肾功能损害。结论:女性尿路生殖道瘘修补手术方法因人因病而定。术前充分准备,选择恰当的手术修补时机、正确的手术修补途径、术中精细操作是提高尿路生殖道瘘手术成功的关键。对复杂性尿瘘,可采用改进三层错位缝合术、辅助带蒂瓣片或网膜技术修补瘘口,促进愈合。     

Results of Closure of Urethrocutaneous Fistulas after Hypospadias Repair

Background:
Urethrocutaneous fistulas are one of the major causes of morbidity after hypospadias repair.
Methods:
During the last 2.5 years, 26 patients underwent repair of 41 urethrocutaneous fistulas. These fistulas were repaired by a 3-layered closure method, by using meticulous surgical techniques aided by optical magnification. In large fistulas, a dermal subcutaneous flap was created and brought over the surgically repaired urethral fistula.
Results:
Twenty-four of the 26 patients with urethrocutaneous fistulas after hypospadias repair had fistula closure, with a 92% success rate.
Conclusion:
A high success rate was obtained with a multilayered closure using meticulous techniques to repair urethrocutaneous fistulas.     

Mathieu's urethroplasty in surgery for hypospadia postoperative complications

The aim of the study was to report the results of meatal based flap urethroplasty called Mathieu urethroplasty, in failed preliminary surgery for hypospadias. PATIENTS AND METHODS: Fourteen boys aged three to 14 years underwent surgery using a meatal-based flap urethroplasty for the correction of prior hypospadia repair complications. The secondary procedure was performed for glandular or coronal urethrocutaneous fistula in ten cases, completely failed urethroplasty in three cases, and for severe meatal retraction in one case. The surgical technique was the same as that used for the primary Mathieu procedures. RESULTS: Only one meatal retraction occurred; the other 13 cases had satisfactory procedure of hypospadias repair failures. Despite the scar skin used for secondary meatal based flap, good results can be achieved specially in two favorite indications: juxta coronal urethrocutaneous fistula and meatal retraction.     

Scrotal dartos flap for the prevention of the urethrocutaneous fistula on hypospadias urethroplasty

BACKGROUND: Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied. PATIENTS AND METHODS: From June 2001 to July 2003, we applied the scrotal dartos flap wrapping technique to prevent the occurrence of urethrocutaneous fistula in 14 patients with hypospadias. RESULTS: Hypospadias was repaired without fistula formation in all but one patient, who developed a tiny fistula which was later closed successfully by a simple procedure. CONCLUSIONS: We recommend the scrotal dartos wrapping technique for covering the neourethra with a well-vascularized flap because of fewer complications, although the procedure to obtain the vascularized flap may take longer.     

尿道下裂修复术后尿道皮肤瘘的治疗

目的:探讨尿道下裂修复术后尿道皮肤瘘尿瘘的治疗方法.方法:收集1995～2004年间42例尿瘘的临床资料.根据瘘口的大小和位置分别采用简单缝合术,Y-V皮瓣成形术、皮瓣推进术进行修补.结果:42例尿瘘修补后39例成功,3例失败,一次修补成功率93%(39/42).结论:遵循尿瘘的修复原则,采用皮瓣技术和多层缝合技术,可提高尿瘘修补的成功率.