不同来源皮瓣对近端尿道下裂修补术预后的影响

Effects of different flaps and preservation of urethral plate on postoperative complication rate following proximal hypospadias repair

目的比较不同来源皮瓣对于近端尿道下裂修补术预后的影响。方法调查2009年7月至2011年12月就诊于我科室近端尿道下裂患者84人，随机应用A（包皮源性）或B（阴囊中隔源性）皮瓣，并根据患者自身阴茎下屈情况行I（保留尿道板之加盖）法或II（非保留尿道板之卷管）法。于术后1月至2年内随访术后常见并发症的发生率。结果共62例患者完成了随访，包括56例近端阴茎型及6例阴茎阴囊型。其中，A组34例，B组2860。A组皮瓣较B组皮瓣尿漏的发生率高（P〈0．05），AI组较AII组阴茎下屈的发生率较高（P〈0．05），尿线变细的发生率较低（P〈0．05），其余的并发症的发生率在AI、AⅡ、BI、BII组之间比较无明显差别。结论包皮源性皮瓣较阴囊中隔皮瓣更易发生尿漏，包皮源性皮瓣卷管法较包皮源性皮瓣加盖法尿线变细、尿漏等并发症发生率升高。

Objective To evaluate the effects of different flaps on the postoperative complications following to proximal hypospadia repair. Methods Total of 84 patients with proximal hypospadias were enrolled in the study during July 2008 and November 2011 in our department. They were randomly divided into two groups by using preputial flap or scorotal septum flap, whether preserved urethral plate or not depended on chordee of penis. They were followed up during lmonth and 2year after operation for any postoperative complications. Results The follow up study was completed in 62 patients, containing 56 proximal penile and 6 penoscrotal. They were allocated into 2 groups according to different flaps, preputial flaps used in 34 cases and scorotal septum flaps in 28 cases. Compared with that of the scorotal septum flap group,there was a higher risk of urinary fistula in preputial flap group （P〈0.05）. Patients in A I group had a higher risk of chordee of penis （P〈0.05） but lower risk of penile chordee（P〈0.05）, compared with that ofA II group. There was no significant difference in other complication rate among the A I, A II, BI and B II group. Conclusion It has a higher risk of urinary fistula to use preputial flap,but the urethral stricture and urinary fistula complications occur frequently in a tube rather the onlay types.