3种尿道下裂尿道成形术251例分析

Snodgrass Technique,Duckett Repair and Bladder Mucosa Grafting for Hypospadias:An Analysis of 251 Cases

目的:总结Snodgrass、Duckett、膀胱粘膜尿道成形3种常用术式治疗中、后段尿道下裂的经验和体会,为临床术式选择提供参考。方法:对1997年至2008年间251例施行Snodgrass、Duckett、膀胱粘膜成形3种术式的中、后段尿道下裂进行回顾性分析。结果:3种术式在中段尿道下裂中成功率分别为80.3%(53/66)、76.0%(19/25)和78.9%(15/19),无明显统计学差异(P均>0.05);后段尿道下裂分别为70.0%(42/60)、63.6%(14/22)和88.1%(52/59),膀胱粘膜尿道成形在后段尿道下裂修补的成功率明显高于Snodgrass式和Duckett式(P<0.05);Ⅱ期手术中,采用膀胱粘膜修补的成功率也明显高于Snodgrass和Duckett术式(P<0.05);<14岁的患儿采用Duckett术式的成功率明显高于≥14岁的患者(P<0.05)。结论:在3种术式中,游离膀胱黏膜成形术更适合于后段尿道下裂患者,<14岁的患儿推荐采用Duckett术式。

Objective ： To present the experience in using the Snodgrass technique, Duckett repair and bladder mucosa grafting for hypospadias. Methods： We retrospectively reviewed 251 cases of middle and posterior hypospadias treated by the Snodgrass technique, Duckett repair and bladder mueosa grafting from February 1997 to December 2008. Results ： The success rates of the Snodgrass technique, Duckett repair and bladder mucosa grafting were 80.3% （53/66） , 76% （ 19/25 ） and 78.9% （ 15/19 ） for middle hypospadias and 68.3% （41/60） , 63.6% （ 14/22 ） and 88.1% （52/59） for the posterior type without statistical significant differences （ all P 〉 0.05 ）. Bladder mueosa grafting showed a significantly higher success rate than the other two procedures in either one-stage or two-stage surgical repair of posterior hypospadias （ P 〈 0.05 ）. Duekett repair achieved a significantly higher rate of success in children under 14 years than in the older ones （ P 〈 0.05 ）. Conclusion ： Of the three surgical options, bladder mucosa grafting is the most suitable for posterior hypospadias, and Duekett repair is recommended for children under 14 years of age.