加盖岛状皮瓣与尿道板纵切卷管尿道成形术在尿道下裂治疗中的应用比较

Onlay island flap and Snodgrass urethroplasty for hypospadias

目的:比较加盖岛状皮瓣尿道成形术(Onlay术)与尿道板纵切卷管尿道成形术(Snodgrass术)在治疗尿道下裂中的优缺点,并探讨术式选择的条件。方法:回顾性总结24例Onlay术和40例Snodgrass术治疗尿道下裂的临床资料,Onlay术组年龄2～10岁,平均4.72岁,其中Ⅱ度22例,Ⅲ度2例,均为初次行尿道成形术者;Snodgrass术组年龄2～13岁,平均4.76岁,其中Ⅱ度36例,Ⅲ度3例,Ⅳ度1例,37例为初次行尿道成形术者,3例为初次尿道成形术失败,再次行尿道成形术者。结果:本组Onlay术有尿瘘5例(21%),阴茎头裂开1例(4%),无尿道狭窄;Snodgrass术有尿瘘7例(18%),阴茎头裂开1例(3%),无尿道狭窄,但有尿道外口狭窄1例(3%),3例再次尿道成形术者未发生并发症。结论:保留尿道板的尿道成形术适用于大多数尿道下裂,可显著降低尿道狭窄等严重并发症的发生。Snodgrass术具有操作简便的优点,且更适用于初次手术失败、需再次行尿道成形术的病例。对于阴茎发育差,尿道板条件不好的初次手术病例,仍以选择Onlay术为宜。

Objective rio compare Onlay island flap procedures and Snodgrass procedures for hypospadias repair, and evaluate the choice between the two. Methods Retrospective analysis of 24 cases of Onlay island flap procedures and 40 cases of Snodgrass procedures. Onlay island flap group were 2 - 10 years old, with an average age of 4.72, including Ⅱ degree 22 cases, and m degree 2 cases, all were primary surgery; Snodgrass group were 2 - 13 years old, with an average age of 4.76, Ⅱ degree 36 cases, Ⅲ degree 3 cases, IV degree 1 case, 37 were primary surgery, 3 were repeat surgery. Results In Onlay island flap group, there were 5 cases with urethral fistula （21%）, 1 case with neourethral dehiscence （4%）, and none with urethral stricture; In Snodgrass group, 7 cases with urethral fistula （18%）, 1 case with neourethral dehiscence （3%）, 1 case with outside of urethral stricture （3%）, 3 repeat surgery cases without complications. Conclusions The urethroplasty with urethral plate is adapt to the majority of hypospadias, significantly reduced urethral stricture and other serious complications. Snodgrass has the advantages of simple operation, and more applicable to the primary surgery failed cases; Onlay island flap is suitable for the primary surgery patients with poor development of penis and urethral plate.