带蒂睾丸鞘膜瓣覆盖在尿道下裂术后尿道裂开手术中的应用

Value of tunica vaginalis flap cover in repair of urethral dehiscence after hypospadias repair

目的探讨应用带蒂睾丸鞘膜瓣覆盖尿道治疗尿道下裂术后尿道裂开的临床疗效。方法回顾性分析2013年5月至2016年5月海南省人民医院治疗30例尿道下裂术后尿道裂开患儿的病历资料,年龄1.5~14岁,平均3.6岁,均采用TIP术式完成尿道成形术后,根据新建尿道的大小和长度,游离合适大小的带蒂睾丸鞘膜瓣,转移覆盖新建尿道。结果 30例患儿一期治愈率为93%,均无并发症发生,术后尿瘘2例(发生率6%),6个月后经尿道瘘修补治愈。其余患儿拔尿管后排尿通畅,所有患儿均获随访,随访时间1~3年,阴茎外观满意,勃起正常,无疼痛,未发生尿道瘘、尿道狭窄和尿道憩室样扩张。结论 TIP术式+带蒂睾丸鞘膜瓣覆盖治疗尿道下裂术后尿道裂开疗效满意,明显减少术后尿道瘘的发生。

Objective To investigate the application of tunica vaginalis flap in repair of urethral dehiscence af-ter hypospadias repair. Methods The clinical data of 30 patients with urethral dehiscence after hypospadias repair from May 2013 to May 2016 were retrospectively reviewed. Their mean age was 3.6 （1.5-14） years at the time of surgery, TIP operation style was performed at first. According to the size and length of the new urethra, the appropriate size of the pedicled tunica vaginalis flap was transferred to cover the new urethra. Results The cure rate of 30 cases in the first op-eration was 93%with no complication;there were two patients （6%） who developed urethral fistula were managed by a second improved operation half a year after the first surgery. All the 30 cases were followed up for one year to three years. There were no urethral fistulas, urethral stricture, urethral diverticulum. Penile cosmesis was excellent and erected well. Conclusion TIP operation with tunica vaginalis flap covering the urethra could enhance success rate effectively in repair of urethral dehiscence after hypospadias repair, and minimize the occurrence of urethral fistula after operation.