尿道下裂手术方法选择再认识

Evaluation of surgical techniques for hypospadias repair

目的探讨不同类型尿道下裂手术方法的选择。方法总结2000-2003年治疗490例尿道下裂的临床经验。无阴茎下弯或轻度阴茎下弯通过阴茎背侧白膜折叠矫正后的尿道下裂手术方法,包括:尿道口位于舟状窝患儿选用尿道口前移、阴茎头成型(MAGPI);尿道口位于阴茎体、阴茎根患儿用加盖岛状包皮瓣法(Onlay);Snod-grass法用于尿道板发育好的远端前型尿道下裂以及部分再次手术病例;合并阴茎下弯的尿道下裂应用带蒂岛状包皮瓣尿道成型术(Duckett)及Duckett+Duplay术式。结果各种手术方法的成功率:MAGPI为95.5％(21／22例);Snodgrass93.3％(14／15例),Snodgrass用于再次手术的患儿效果72.4％(21／29例);Onlay95.5％(213／223例);Duckett90.8％(157／173例);Duckett+Duplay81.6％(31／38例)。结论应根据尿道下裂有无合并阴茎下弯及尿道开口位置和阴茎发育的状况选择手术方法。

Objective To evaluate different surgical procedures for hypospadias repair. Methods The clinical data of 490 cases with hypospadias were analyzed retrospectively from 2000 to 2003. Three procedures were undertaken for hypspadias without chordee or mild curvature, including MAGPI for cases with glandular hypospadias, Snodgrass for cases with distal and midpenile meatal based hypospadias, and Onlay island flap for cases with anterior hypospadias. Preputial island flap(Duckett), Duckett +Duplay were adopted for hypspadias with chordee. Results The success rate from MAGPI procedure was 95.5% (21/22); from Snodgrass was 93. 3% (14/15);from Snodgrass for redo hypspadias was 72. 4% (21/29);from Onlay island flap was 95. 5% (213/223);from Duckett was 90. 8% (157/173) ;and from Duckett + Duplay was 81. 6% (31/38); respectively. Conclusions Duckett and Duckett + Duplay procedure are recommended for hypspadias with chordee; MAGPI, Snodgrass and Onlay island flap procedures are recommended for hypspadias without chordee based on the different location of meatus and the phallus development variants.