减少Duckett手术治疗尿道下裂并发症发生的体会

Clinical experience on reducing the failure rate of Duckett's operation in treatment of hypospadias patients

目的探讨提高Duckett术式治疗尿道下裂手术成功率的技术要点。方法2000至2008年采用Duckett手术Ⅰ期治疗尿道下裂共57例病例。分A组(2000年至2005年手术的)和B组(2006年至2008年手术的)进行手术成功率、尿瘘及尿道狭窄发生率的分析比较。结果B组手术成功率高于A组,尿瘘和尿道狭窄等并发症发生率更低(P<0.05)。结论Duckett手术要注意带血管蒂皮瓣的分离层面以及尿道管的缝合技术。血管蒂筋膜覆盖尿道管可以减少尿瘘发生。术中要注意消灭创面死腔。尿道吻合口和尿道外口缝合要宽敞。熟练掌握并灵活运用Duckett术式可以减少尿道下裂并发症的发生。

Objective To discuss the key points of Duckett＇s operation in treatment of hypospadias patients. Methods Total of 57 hypospadias patients who underwent Duckett＇s operation from 2000 to 2008 were divided into groupA （2000-2005） and groupB （2006-2008）in the study. The success rate of operation, incidence rate of urethrocutaneous fistula and urethrostenosis were comparatively analyzed between group A and group B. Results The success rate of group B was higher than that of group A, whereas the incidence rate of complications in groupB was lower than that in group A （P〈0.05）. Conclusion The anatomical layer of vascular pedicle skin flap and the skill of suture were important for Duckett＇s operation. The incidence of urethrocutaneous fistula can be minimized by vascular pedicle fascia covering the urethra. The dead space of wound should be avoided in the process of operation. Urethral anastomosis and external orifice should be spacious. Subtle and proficient surgical skill can reduce the complications of hypospadias repair.