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目的总结分析重度尿道下裂手术后尿道狭窄患儿尿道扩张治疗的经验。方法选择2010年1月至2015年6月南京医科大学第二附属医院重度(阴茎阴囊型、阴囊型和会阴型)尿道下裂患儿10例,年龄1.5~6.0岁,平均年龄3.0岁。回顾其手术治疗情况及手术后复查期间尿道扩张术治疗尿道狭窄情况,包括手术术式及分期,尿道扩张时间及过程,扩张后排尿情况。结果 10例患者均在术后1个月左右尿线开始变细时行尿道扩张治疗,其中6例可以顺利进行常规尿道扩张,扩张后排尿满意,间隔1个月进行再次扩张,术后3个月结束尿道扩张治疗进入常规随访,无排尿困难;4例患者常规尿道扩张困难转入全身麻醉下膀胱镜直视尿道扩张治疗,其中2例在9 F镜鞘下膀胱镜可顺利通过吻合口,随后常规扩张后置入10 F硅胶导尿管并留置,1周后拔管,另2例因9 F镜鞘下膀胱镜难以通过吻合口,故在监视下置入硬膜外麻醉导管入膀胱,随后在导管引导下置入8 F硅胶导尿管成功,留置1周后拔出,此4例患者均间隔1个月再次扩张,此后随访无明显排尿困难。结论对于难以常规尿道扩张的重度尿道下裂术后严重尿道狭窄患儿,膀胱镜技术是一个安全有效的辅助手段,可以提高成功率,降低盲目扩张造成尿道损伤和盲道发生的可能。
Objective To summarize the experience of urethral dilatation in children with urethral stricture after severe hypospadias operation. Methods From January 2010 to June 2015, 10 patients with severe hypospadias (penis scrotum, scrotum and perineal) hypospadias in the Second Affiliated Hospital of Nanjing Medical University from January 2010 to June 2015 were aged from 1.5 to 6.0 years with an average age of 3.0 years. The surgical treatment and urethral dilatation during urethral stricture were retrospectively reviewed, including surgical procedures and staging, time and course of urethral dilatation, urination after dilation. Results All the 10 patients underwent urethral dilatation at about 1 month after the operation. The urethral dilation was performed in 6 of them. Conventional urethral dilatation was performed in 6 of them. Satisfactory voiding was performed after dilation. Urethral dilatation at the end of the month was routine follow-up, with no difficulty in urinating. Four patients underwent general urethral dilatation with direct urethral dilation under general anesthesia. Among them, 2 cases underwent 9 F-mirror cystoscopy to successfully pass the anastomosis, Subsequently, after routine expansion, 10 F silicone catheters were placed and left indwelling, extubation was performed after 1 week, and the other 2 cases were difficult to pass anastomosis through 9 F-mirror cystoscopy. Therefore, epidural anesthesia catheter , Followed by catheterization into the 8 F silicone catheter successfully indwelling one week after the pull-out, the four patients were re-dilated at intervals of 1 month, followed by no obvious dysuria. Conclusions Cystoscopy is a safe and effective adjunct to children with severe urethral stricture who are hard to routine urethral dilatation after severe hypospadias, which can improve the success rate and reduce the possibility of urethral injury and blindness caused by blind expansion.