应用Snodgrass术与Duckett术式治疗尿道下裂的疗效对比分析

Comparative analysis of the curative effect of Snodgrass and Duckett surgical style in the treatment of hypospadias

目的总结应用尿道板纵切卷管成型术(Snodgrass术)与带蒂岛状包皮皮瓣成型术(Duckett术)治疗尿道下裂的经验和体会,并比较其疗效。方法对2005年3月至2010年11月间施行Snodgrass、Duckett术的146例患者的疗效进行回顾性分析。结果 Snodgrass组一次手术成功率为91.5%(65/71),Duckett组一次手术成功率为85.3%(64/75),两组一次手术成功率差异无统计学意义(χ2=0.43,P>0.05)。Snodgrass组患者手术时间、术中出血量、术后下床时间均少于Duckett组(t=6.34,t=4.32,t=4.23,均P<0.05),而两组住院时间差异无统计学意义(P>0.05)。Snodgrass组术后尿道狭窄发生率(1.4%)显著低于Duckett组(12.0%),P<0.05,而两组尿瘘、阴茎扭转发生率差异无统计学意义(P>0.05)。结论 Snodgrass术手术操作简单,尿道成型取材方便,术程简捷,对患者损伤少,术后并发症少,尿道板发育良好且不伴严重下弯者,首选Snodgrass术,对尿道板发育不良或合并严重下弯畸形者可采用Duckett术。

Objective To summarize the experience of Snodgrass and Duckett technique in the treatment of hypospadias, and to compare the curative effect between the two surgical styles. Methods The curative effect of 146 patients with hypospadias treated by Snodgrass or Duckett from March 2005 to November 2010 was retrospectively analyzed. Results The primary success rate was 91.5% in the Snodgrass group and 85.3% in the Duckett group, with no statistically significant difference between the two groups （x^2=0.43, P〉0.05）. The average operation time, the average ambulant time and the blood loss in the Snodgrass group were all shorter or less than that in the Duckett group （t= 6.34, t=4.32, t=4.23, P〈0.05）. No significant difference was found in the average length of hospital stay between the two groups. The incidence of urethral stricture was found lower in the Snodgrass group （1.4%） than that in the Dukett group （12.0%）, but no significant difference was found in the incidence of urinary fistula and penis twisting. Conclusion Because of the simple operation, convenient urethral molding materials, and less postoperative complications, Snodgrass technique is preferred for patients with well developed urethral board and mild under bending. For patients with serious dysplasia deformity urinary board or serious under bending, Duckett can be used.