不同术式一期修复男童尿道下裂

One-stage repair for 205 cases of boy hypospadias with different procedures

目的 评价不同术式一期修复男童尿道下裂的疗效。 方法 1995年至 2 0 0 2年间共收治尿道下裂及其并发症 32 3例 ,其中年龄 <14岁 2 4 2例 ,除并发症病例外 ,施行尿道下裂成形手术2 0 5例。其中带蒂包皮皮管尿道成形术 (Duckett) 12 7例 ,原位阴囊皮管加带蒂包皮皮管 (Duplay加Duckett) 2 5例 ,膀胱黏膜代尿道 16例 ,阴茎原位皮管 16例 ,带蒂包皮皮瓣相嵌 (Onlay) 9例 ,尿道口近端带蒂皮瓣翻卷 (Mathieu) 7例 ,尿道口前移 (MAGPI) 5例。 结果 术后发生尿瘘 19例 ,尿道外口狭窄 1例 ,总成功率 90 .2 %。总并发症发生率 9.8%。其中Duckett术式并发症 7.8% (10 / 12 7) ,阴茎原位皮管 12 .5 % (2 / 16 ) ,Mathieu术 2 8.6 % (2 / 7) ,Duplay加Duckett术 16 .0 % (4/ 2 5 ) ,膀胱黏膜代尿道 6 .3% (1/ 16 ) ,Onlay 11.2 % (1/ 9)。 结论 严格掌握不同术式的适应证 ,根据患儿情况灵活选择术式可降低并发症发生率。

Objective To evaluate surgical results an d choice of various procedures for hypospadias repair in boys.323 cases of hypospa dias were treated from 1995-2002,and of these,205 boys whose average age was 5.1 years had underwent different surgical procedure for hypospadias. M ethods 205 boys with hypospadias were retrospectively analysed.MAGPA (5 cases),Mathieu(7),Onlay island flap(9) were given to boys of hypospadias wit hout chordee.Duckett procedure (127),Modified Denis-Browne (16),Bladder mucosa graft technique (16),Duckett plus Duplay techniques(25) were adopted for hypospa dias with chordee. Results There were 19 cases with uret hra fistula and 1 case with external orifice stricture of urethra.The success ra te for all cases was 90.2%,and morbidity of all complications was 9.8%.The compl ication for Duckett techniques was 7.8%(10/127),Modified Denis-Browne 12.5%(2/1 6),Mathieu 28.6%(2/7),Duplay plus Duckett 16.0%(4/25),Bladder mucosa graft techn ique 6.3%(1/16) and Onlay 11.2%(1/9). Conclusions It is suggested that a complete mastery of applications for different surgical approac h and a proper selection of various surgical methods according to individual pat ient’s condition can reduce complication of operation.