对尿道下裂分期手术的重新认识

Renewed concept on staged repair for hypospadias

在尿道下裂学知识积累、技术进步、术式多样化的今天,一期完成矫治的技术越趋成熟,但少数重型病例及多次手术失败后的残废性尿道下裂病例,需要重建尿道长度大,阴茎阴囊发育差,局部可用重建尿道替代材料短缺,且合并其他畸形,如阴茎阴囊转位、阴囊对裂、阴茎隐匿、前列腺小囊等,进行一期修复,则可能重建外形差,并发症率较高,再手术更为困难,对其选择分期矫治手术并采用恰当的策略是合理的选择。

Based on evolution of knowledge and development of technology,a large number of procedures have been involved in hypospadias repair. Techniques for single stage repair mature with time while room for staged repair is still set aside for those extreme cases or hypospadias cripple. When the patient is categorized as the most severe type, or with several pervious failed surgeries, long segmental urethral defect needs substitution, associated malformations such as penoscrotal transposition, scrotal bifida, and prostate utricle, necessitate correction ,whereas local tissue useful for reconstruction is quite limited. Single stage repair for such eases is accompanied with high risk of postoperative complications and unacceptable cosmesis. Staged repair may be rationale on such occasions.