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目的探讨一期手术修复在婴幼儿膀胱外翻尿道上裂综合征治疗中的应用及疗效。方法 9例膀胱外翻尿道上裂综合征患者,均为男性,年龄3d~1岁,平均年龄21.3w。全部采用Mitchell法完全一期修复手术,腹膜外充分游离膀胱,将膀胱、膀胱颈及尿道一同关闭,均未行骨盆截骨术,术后采取适当制动,用改良Cantwell-Ransley法修复尿道上裂。结果 9例膀胱外翻尿道上裂综合征患者中7例均一期修复成功,2例膀胱、腹壁裂开,其中1例已行可控尿流改道术。3例患儿术后出现轻度切口感染,经换药及抗炎治疗后愈合良好,无一例出现龟头或海绵体缺血坏死,无尿瘘、尿道狭窄及尿道下裂等并发症。术后阴茎外观满意,平均随访1a,肾功均正常,无一例出现膀胱输尿管返流。结论一期手术治疗婴幼儿膀胱外翻尿道上裂综合征疗效可靠,并发症少,临床可推广使用。应根据外翻膀胱大小、耻骨分离程度、患儿一般情况等选择行一期手术修复。
Objective To investigate the application of primary surgical repair in the treatment of infantile urinary bladder over the sprung syndrome and its curative effect. Methods Nine patients with bladder upturns syndrome were all male, aged from 3 to 1 years old with an average age of 21.3 weeks. All using Mitchell method a complete reoperation, peritoneal full of free bladder, the bladder, bladder neck and urethra with the closure, did not perform pelvic osteotomy, after appropriate braking, with modified Cantwell-Ransley method to repair the urethra crack. Results Of the 9 patients with supraphthis syndrome, all the 7 cases were repaired in one phase, and 2 cases had rupture of bladder and abdominal wall. One of them had controllable urinary diversion. Three cases of postoperative mild incision infection, healing after dressing and anti-inflammatory treatment, no case of glaucoma or cavernous necrosis, no urinary fistula, urethral stricture and hypospadias and other complications. Postoperative appearance of the penis was satisfactory, the average follow-up 1a, renal function were normal, no case of vesicoureteral reflux. Conclusions The first-stage surgical treatment of infantile urinary bladder over the sprung syndrome is reliable, with fewer complications and can be used clinically. Should be based on the valgus bladder size, pubic level, the general situation of children choose a line of surgical repair.