改良Koyanagi术一期修复伴有阴茎阴囊转位的重度尿道下裂

Modified Koyanagi technique for repairing severe hypospadias patients with penoscrotal transposition

目的探讨改良Koyanagi术一期修复伴有阴茎阴囊转位重度尿道下裂的临床效果。方法改良Koyanagi术修复伴有阴茎阴囊转位重度尿道下裂22例。新尿道长度平均为4.7(3.5～9.0)cm。术后尿液转流时间平均10.8(10～1 3)d。结果一期手术成功1 8例(81.8%)。尿瘘4例,其中伴尿道外口狭窄1例经尿道扩张后治愈,伴伤口裂开1例。尿瘘均位于阴茎阴囊交界近端。尿瘘再次修补成功率为66.7%(2/3)。超过2次以上手术1例。随访6个月以上,阴茎外观的满意度为72.7%(1 6/22);20例获尿流率的随访,平均年龄为5.2岁,梗阻型尿流曲线为:70%(14/20)。结论该术式符合解剖生理,是一种较理想的一期修复伴有阴茎阴囊转位的重度尿道下裂的手术方式。

Objective To evaluate the effect of modified Koyanagi technique for repair of severe hypospadias with penoscrotal transposition. Methods A total of 22 severe hypospadias patients with penoscrotal transposition were treated with modified Koyanagi technique. Suprapubic diversion was used for drainage suprapublic tube were removed 10-13days after operation,and then followed up. Results Of 22 patients, 18 cases were cured successfully by one-stage operation and4 patients suffered from penoscrotal proximal fistulas. The successful rates of the fistula re-repairing was 66.7%（2/3）, 1 cases received many a time operations. After 6 months, 72.7% patients had a good cosmetic appearance in penises. A plateau uroflow curve （vs normal bell curve） was observed in 14 of 20 followed-up cases （ 70% ）. Conclusion It might be a good alternative approach for treatment of severe hypospadias. Long term following-up and realtime monitoring was needed for the value of Modified Koyanagi technique on repair of severe hypospadias patients