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目的探讨成人尿道下裂的临床特点,提高成人尿道下裂的手术成功率。方法2001年9月至2005年12月治疗16-62岁(平均22．9岁)尿道下裂28例,共计施行各种手术39例次,其中尿道成形手术34例次,单纯补瘘5例次。通过临床观察、随访,对几种常用手术方法进行评估。此外,根据成人特点设计改良了术后包扎方法以帮助提高手术的成功率。结果28例单次手术的成功率19例(67．9％)。尿道成形术的34例次共发生尿瘘10例次(29．4％),其中1例在术后2个月自愈(尿瘘发生率26．5％)。发生尿瘘的分布为:Snodgrass术7例次(7／21,33．3％),镶嵌式唇粘膜尿道成形术1例次(1／7,14．3％),Duckett术1例(1／2,50％),Methieu术1例。单纯补瘘的5例中1例术后尿瘘复发。尿道成形术后尿道狭窄发生6例(6／34,17．6％),4例表现为严霞尿道狭窄。尿道狭窄发生的分布为:4例发生于用Snodgrass方法的再手术病例(4／21,19％),1例发生于Duckett术后(1／2,50％),另1例发生于邻近包皮皮瓣再次尿道成形术后。5例目前已经镶嵌式唇粘膜尿道成形术再次手术治愈,1例等待再次手术。结论成人尿道下裂手术容易出现并发症,手术方法的选择是减少并发症的关键。合理的阴茎包扎方法和术后处理对手术的成败有重要影响。
Objective To investigate the clinical features of adult hypospadias and improve the success rate of adult hypospadias surgery. Methods From September 2001 to December 2005, 28 cases of hypospadias aged 16-62 years (mean 22.9 years) were treated with a total of 39 procedures, including 34 cases of urethroplasty and 5 cases of simple fistula Times. Through clinical observation, follow-up, several commonly used surgical methods were evaluated. In addition, according to the characteristics of adults improved postoperative dressing method to help improve the success rate of surgery. Results The success rate of single operation in 28 cases was 19 cases (67.9%). A total of 34 cases of urethroplasty occurred in 10 cases (29.4%) of urinary fistulas, of which 1 case was cured 2 months after operation (the incidence of urinary fistula was 26.5%). The distribution of urinary fistula occurred in 7 cases (7 / 21,33.3%) with Snodgrass technique, 1 case (1 / 7,14.3%) with mosaic lip and urethroplasty, 1 case with Duckett’s surgery (1 / 2,50%), Methieu surgery in 1 case. One case of recurrent fistula was found in 5 cases of simple fistula. Urethral urethral stricture occurred in 6 cases (6 / 34,17.6%), 4 cases showed stricture urethral stricture. The distribution of urethral strictures occurred in 4 cases (4/21, 19%) with re-operation with Snodgrass method, 1 case occurred after Duckett’s surgery (1/2, 50%) and the other occurred in adjacent foreskin Flap again after urethroplasty. 5 cases have been inlaid lip mucosa urethroplasty surgery again, 1 case waiting for reoperation. Conclusions Adult hypospadias surgery is prone to complications, the choice of surgical methods is the key to reduce complications. Reasonable penile banding and postoperative management of the success or failure of surgery have a significant impact.