带蒂包皮双面皮瓣治疗小儿尿道下裂

Pedicled preputial double-faced island flap urethroplasty for hypospadias in children

目的探讨带蒂包皮双面皮瓣尿道成形术（PPDIF）治疗小儿尿道下裂的适用范围和疗效。方法尿道下裂患儿99例。年龄4个月～12岁，平均5．1岁。按Barcat分型：阴茎体型56例、阴茎阴囊型24例、阴囊型13例、会阴型6例。在Duckett术基础上，保留部分包皮外板皮肤连同成形尿道转移至腹侧，覆盖新生尿道。结果99例随访2年。术后发生尿瘘8例（8．1％）、尿道狭窄1例（1．0％）、皮瓣坏死1例（1．0％）。手术总成功率89．9％（89／99）。其中单纯应用PPDIF修复阴茎体型或阴茎阴囊型尿道下裂成功率91．2％（73／80），联合尿道口周围皮瓣（Duplay）术修复阴囊型或会阴型尿道下裂为84．2％（16／19）。结论PPDIF适用于大多数小儿尿道下裂的治疗，术后外形美观。重度尿道下裂患儿联合Duplay矫正疗效肯定。

Objective To discuss the indication and efficacy for treating hypospadias with urethroplasty of Pedicled preputial double-faced island flap（PPDIF）. Methods Records of 99 children （mean age, 5.1 years; age range, 4 months 12 years）with hypospadias who underwent PPDIF operation were reviewed. Of them, 56 cases were penile type of hypospadias, 24 cases of penile root type, 13 cases of scrotal type and 6 cases of perineal type according to Barcat classification. Based on Duck ett technique, the partial preputial cortical plate remained and was displaced to gastr-penis with urethra. , and finally the new urethra would be covered by the cortical plate. Results During follow-up of average 2 years, 8 patients（8.1% ） developed urethral fistula, 1 （1.0 %） developed mild meatal ste nosis, and 1 （1.0 %） developed flap necrosis. The success rate for total PPDIF procedure was 89.90 （89/99）. And the success rate of simple PPDIF for cases with penile and penile root hypospadias, and PPDIF＋Duplay for cases with scrotal and perineal hypospadias were respectively 91.25 % （73/80） and 84.21%（16/19）. respectively. Conclusions PPDIF is good for treating most hypospadias. Furth more it make penis better shape. In the severe cases, PPDIF＋Duplay prededure is recommended and the effect was affirmative.