尿道板纵切卷管尿道成形术治疗尿道下裂810例报告

Tubularized incised-plate urethoplasty for hypospadias(810 cases)

目的评价尿道板纵切卷管尿道成形治疗尿道下裂临床疗效。方法回顾分析该院2002年3月~2011年1月接受尿道板纵切卷管尿道成形治疗的810例尿道下裂患者临床资料。手术年龄1~17岁,平均2.1岁,均采用尿道板纵切卷管成形法。结果术中尿道下裂程度按Duckett分型：前型316例（39.0%）、中间型348例（43.0%）、后型146例（18.0%）。阴茎下弯程度按照Donnahoo分级,将尿道下裂阴茎下弯程度分为0~4级。随访6月至2年,746例手术一次成功（92.1%）,150例3级阴茎下弯者采用阴茎背侧白膜折叠术纠正完成手术,新建尿道口位于阴茎头部,阴茎外观类似于包皮环切术后形态。术后并发尿道口狭窄11例（1.4%）,9例经再手术治疗后治愈,2例行尿道扩张后治愈。并发尿瘘49例（6.0%）,39例经再手术修补治愈。尿道憩室4例（0.5%）,均经手术治疗后治愈。结论尿道板纵切卷管尿道成形术适合于大多数尿道下裂患者,阴茎重度弯曲者若需采用尿道板纵切卷管尿道成形术则需行背侧海绵体折叠术。

【Objective】 To evaluate the clinical efficacy of tubularized incised-plate urethoplasty for hypospadias repair.【Methods】 810 cases of hypospadia patients ranged from 1 to 17 years（mean,2.1 years） treated with tubularized incised-plate urethoplasty from March 2002 to January 2011 were reviewed.All patients were performed in tubularized incised-plate urethoplasty.【Results】 The position of the meatus was distal in 316 boys（39.0%）,middle in 348（43.0%） and posterior in 146（18.0%） according to Duckett classification.The severity of chordee was graded into 0～4 according to Donnahoo classification.810 patients were followed up from 6 months to 2 years（mean,7.5 months）.746（92.1%） patients were successful cured after just one repair,obtaining a neourethra with slit-like meatus at the top of the glans and satisfactory voiding function.150 patients of grade 3 chorde repair with dorsal placation with phallocampsis.Small urethrocutaneous fistula occurred in 49（6.0%） patients and 39 of them were cured by the second therapy.11（1.4%） patients developed mild meatal stenosis and were successfully managed.Urethral stricture was not seen during follow-up.Urethral diverticulum occurred in 4（0.5%） patients which were cured by the second therapy.【Conclusion】 Tubularized incised plate urethroplasty is versatile to most types of hypospadias and to severity chordee type of hypospadias by using dorsal placation with phallocampsis.