阴囊正中带蒂皮瓣尿道下裂修复术远期疗效

Long term follow up of hypospadias repaired with scrotal median pedicle flap

目的:评价阴囊正中带蒂皮瓣在尿道下裂修复中的价值。方法:对采用该手术的31例尿道下裂患儿进行随访,观察该手术的远期疗效。结果:其中20例获得5.5～8年(平均7年)的随访,效果满意者8例,尿道未正位开口12例,阴茎下曲5例,尿线无力8例,尿道结石5例,尿道毛发4例。结论:在儿童本术式成形阴茎外观欠满意,尿道不易正位开口,远期并发症如尿道结石、尿道毛发、继发下曲等发生率较高,但在阴茎包皮材料不足以修复较长段下裂时,联合包皮瓣手术,或在包皮瓣手术失败后作为再次手术具有肯定价值。带蒂包皮瓣一期修复伴有下曲的尿道下裂应作为首选。

Purpose:To appraise the value of scrotal median pedicle flap in repairing hypospadias.Methods:31 cases of hypospadias in children were repaired with scrotal median pedicle flap between 1986～1988.20 cases of which have been followed up 5.5～8 years (mean 7 years) after operation. Results:8/20 cases were satisfactory, abnormal meatus 12 cases, penise with residual chordee 5 cases, weakness of streem 8 cases, urethrolith 5 cases, and hair in neourethra 4 cases. Conclusions:It is hard to achieved satisfied appearance and normal meatus in this group by urethroplasty with scrotal median pedicle flap. Long term complication rate such as urethrolith, hair in urethra and residual chordee are higher than that of urethroplasty with prepucal flap. There is some value of the operation when prepuce is not enough to construct a long neourethra, it is appropriate to use this technique as a supplementary procedure. Hypospadias with chordee repaired in one stage uretnroplasty with pedicle preputial flap should be considered as a first choice.