尿道口旁单侧包皮瓣加盖尿道成形术修复远端尿道下裂的疗效分析

Onlay urethroplaty with one-lateral parameatal foreskin flap repair for distal hypospadias

目的 探讨远端尿道下裂合理有效的手术方式.方法 采用尿道口旁单侧包皮瓣加盖尿道成形术（OUPF术）51例,尿道板纵切卷管成形术（TIPU术）56例.2组年龄分别为4.9（3～17）和5.1（2～19）岁.病理分型：OUPF组冠状沟型、阴茎体前型、阴茎体中间型分别为6、14、31例;TIPU组分别为5、17、34例（P〉0.05）.统计学比较2种患儿手术时间、并发症、再手术率、术后外观、术后尿流率等参数.结果 OUPF组与TIPU组手术时间分别为（103±29）min和（92±21）min,术后尿瘘发生率分别为7.8%（4/51）和14.2%（8/56）,6个月后外观满意度分别为84.8%（39/46）和87.8%（36/41）,2组比较差异均无统计学意义（P〉0.05）.87例平均随访15（6～47）个月,OUPF组46例,TIPU术组41例.2组并发症总发生率分别为15.7%（8/51）和32.1%（18/56）,再手术率分别为7.8%（4/51）和26.8%（15/56）,2组比较差异均有统计学意义（P〈0.01）.尿流率随访76例,OUPF组39例,TIPU组37例,＂平台梗阻型＂尿流曲线分别为33.3%（13/39）和67.6%（25/37）,平均尿流率分别为9.4（3.2～17.1）和6.8（3.3～15）ml/s,最大尿流率分别为12.2（3.9～22.9）和8.3（3.7～18.1）ml/s,2组比较差异均有统计学意义（P〈0.01）.结论 OUPF术符合解剖学结构,优于TIPU术,是远端尿道下裂理想的手术方式.

Objective To compare two operative approaches for treatment of distal hypospadias. Methods One hundred and seven patients were recruited into the study. Group1（n=51） underwent OUPF and group2（n= 56） underwent TIPU repair. The results were analyzed with Chi-square and two Sided test. Results Operative times for OUPF and TIPU repair were （103±29） min and （92±21）min respectively （P〉0.05）. Fistula occurred rates were 7.8% （4/51）and 14.2% （8/56） （P〉0.05）. Satisfied rates for the appearance of the penis post-operation were 84.8% （39/46）and 87.8%（36/41） respectively （P〉0.05）. 87 patients were followed up. With mean follow-ups of 15 months （range 6 to 47） , the overall complication rates were 15.7% （8/51） and 32.1 % （18/56）（P〈0. 05） for OUPF and TIPU repair. Only 4 of 51 patients （7.8%） undergoing OUPF underwent re-operations, compared to 15 of 56 patients （26.8%） undergoing TIPU repair （P〈0.001）. A plateau uroflow curve （vs normal bell curve）was observed in 33.3% （13/39）and 67.6（25/37） ,respectively（P〈0. 001）. The average flow rate was 9. 4 ml per second （range 3. 2 to 17. 1） in patients undergoing OUPF repair, compared to 6. 8 ml per second （3. 3 to 15, P〈0. 05） for those undergoing TIPU repair. Mean peak flow rates were12.2 ml per second （range 3.9 to 22.9） and 8. 3 mi per second （range 3.7 to 18. 1, P〈0.01） for OUPF and TIPU procedures. Conclusion OUPF is superior to TIPU in the surgical treatment of distal hypospadias.