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目的探讨尿道下裂患儿合并血友病时围手术期的处理方法及相应并发症的应对策略。方法选取我院2006~2015年9年以来收治的尿道下裂合并血友病患儿27例的围手术期处理方案作为研究对象。甲型血友病21例,乙型血友病6例.尿道下裂分型,阴茎头型5例,前阴茎型8例,后阴茎型7例,阴茎阴囊型7例,27例患者均需行尿道下裂修复术。结果围手术期通过对患儿凝血功能,ⅧC和ⅨC活性等指标的监测,凝血因子、凝血酶原复合物、新鲜冰冻血浆输注等血液替代治疗,患儿27例均顺利完成手术,患儿1例术后10天再发伤口出血,患儿2例伤口愈合延迟,患儿5例转移皮瓣皮下血肿坏死形成尿瘘。结论尿道下裂手术属于先天畸形矫正整形,术后伤口愈合情况对于手术成功率影响较大,充分的围手术期准备计划和突发状况的应对可有效降低血友病患儿凝血功能异常对于手术效果的影响。
Objective To investigate the perioperative management and corresponding strategies of hemophilia in children with hypospadias. Methods 27 cases of hypospadias with hemophilia in our hospital from 2006 to 2015 were selected for perioperative management. 21 cases of hemophilia A and 6 cases of hemophilia B. The typing of hypospadias, 5 cases of penis head type, 8 cases of anterior penis type, 7 cases of posterior penis type, 7 cases of penis scrotum type and 27 cases of patients Need for hypospadias repair. Results In perioperative period, 27 cases of children were successfully completed the operation by monitoring blood coagulation, activity of Ⅷ C and Ⅸ C, coagulation factors, prothrombin complex, and fresh frozen plasma infusion. One case had hemorrhage after 10 days. The wound healing was delayed in 2 cases and the necrosis of 5 cases with subcutaneous hematoma of the transfer flap formed urinary fistula. Conclusions Hypospadias surgery belongs to orthopedic deformity surgery. Postoperative wound healing has great influence on the success rate of surgery. Adequate perioperative preparation plan and emergency response can effectively reduce coagulation abnormalities in children with hemophilia. Effect of effect.