背侧白膜紧缩在尿道下裂阴茎下弯中的应用

Application of dorsal tunica albuginea plication for correction of hypospadias curvature

目的回顾总结合并阴茎下弯的尿道下裂手术治疗，探讨阴茎背侧白膜紧缩在尿道板切断后残留阴茎下弯的尿道下裂病例中的应用。方法我院2006年1月至2010年12月应用横裁包皮岛状皮瓣管状尿道成形术（Duckett法）修复合并阴茎下弯的尿道下裂746例，平均年龄3．1岁。切断尿道板，松解尿道板以及尿道周围纤维索带，做阴茎海绵体人工勃起试验检查阴茎下弯矫正效果，对残留阴茎下弯病例做背侧白膜紧缩。术后随访6个月，了解术后效果以及手术并发症情况。结果本组病例中，应用Duckett手术611例，其中207例行背侧白膜紧缩；对于尿道缺损长的病例应用Duckett＋Duplay手术135例，其中63例行背侧白膜紧缩。应用白膜紧缩共270例，出现并发症56例，未应用白膜紧缩共476例，出现并发症120例。需要应用背侧白膜紧缩病例中，阴茎体型病例比阴茎阴囊型和会阴型病例少（P＜0．001），Duckett组的病例较Duckett＋Duplay组应用少（P=0．005）。应用白膜紧缩与未应用白膜紧缩两组比较，手术效果以及术后发生并发症的差异无统计学意义（P〉0．05），白膜紧缩后的病例无阴茎头血供障碍者。结论利用背侧白膜紧缩方法矫正尿道下裂在尿道板切断后残留阴茎下弯的病例中应用效果满意。

Objective To review the surgery for hypospadias combined with ventral penile curvature,and to discuss the application of dorsal tunica albuginea plication for residual hypospadias curvature. Methods From Jan 2006 to Dec 2010,there were 746 cases of hypospadias repamy ired by Duckett＇s procedure. The average age at operation was 3. 1 years old. 270 cases of residual hypospadias curvature were treated with dorsal tunica albuginea plication technique to straighten the penis. The surgical procedure was as follows： The urethral plate was cut, the dysplastic fascial band around the ventral tunica albuginea was partially excised. Erection test by normal saline injection through a butterfly needle into one corporal body was done. Residual hypospadias curvature was treated with the dorsal tunica albuginea plication after the neurovascular bundle was carefully dissected free. Follow up was done for 6 months after the operation. Results There were 611 cases treated by Duckett＇s procedure with 207 cases of dorsal tunica albuginea plication. 135 cases of Duckett ＋ Duplays procedure were done with 63 cases of tunica albuginea plication. In the 270 cases of dorsal tunica albuginea plication, there were 56 cases of complications, and in 476 cases of no plication, there were 120 cases of complications. In the cases of tunica albuginea plication, cases of penile type were less than penoscrotal or perineal type （P〈0. 001）. The cases of Duckett group were less than the group of Duckett ＋ Duplay. Compared with group of tunica albuginea plication and group of no plication, the outcome of surgery showed no significant difference statistically. Conclusions Dorsal plication of the tunica albuginea is a simple and effective method for correcting residual hypospadias curvature. This technique prevents damage to the neurovascular bundles and erectile function.