Koyanagi手术+睾丸鞘膜覆盖技术治疗重型尿道下裂30例

Koyanagi Operation and Technique of Perididymis Covering in the Treatment of 30 Cases with Severe Hypospadia

目的：评价Koyanagi手术＋睾丸鞘膜覆盖技术治疗重型尿道下裂的疗效。方法：30例尿道下裂患者行Koyanagi手术＋睾丸鞘膜覆盖技术，年龄11个月~3岁，阴茎阴囊型16例，阴囊型9例，会阴型5例。全部病例均有不同程度的阴茎下弯。阴茎发育不良21例，术前均肌注hCG 1~2个疗程使龟头直径达1.2 cm，停药1个月后手术。合并阴茎阴囊转位18例，均一次矫正。手术时间平均2.5 h，10~12 d拔除5号引流管，带9号支架管排尿。一般3周左右支架管自行脱落。1个月后常规行尿道扩张1~3个月，每周1次。结果：30例均顺利实施Koyanagi术式，术后随访1~3年，冠状沟小尿瘘3例（10.0%），尿道狭窄2例（6.7%），狭窄继发尿道憩室1例（3.3%）。除1例不能定期尿扩尿瘘需二次修补外，其余均经规则扩张获治愈，避免二次修补。总治愈率96.7%，且阴茎外观满意，接近包皮环切外形，无阴茎下弯。结论：Koyanagi手术＋睾丸鞘膜覆盖技术治疗重型尿道下裂，外观满意，并发症少，是较理想的手术方式。

Objective：To explore the effect of koyanagi operation and technique of perididymis covering in the treatment of severe hypospadia. Method：A total of 30 cases with hypospadias were cured by koyanagi operation and technique of perididymis covering. Patients ages were from 11 months to 3 years old. Among the 30 cases there were 16 cases diagnosed as penoscrotal hypospadias and 9 cases with scrotal type of hypospadias and 5 cases with perineal hypospadias. All those cases had different degrees of chordee of penis. All 21 patients diagnosed as maldevelopment of penis were given intramuscular injection hCG for one or two course before operation in order to make the glans diameter be up to 1.2 cm,and the surgical procedure was done one month after the hCG course. All 18 patients combined with the penis and scrotum transposition were rectified successfully by one time. The average operation time was 2.5 hours,and the drainage tube was removed in 10-12 days after operation and the stent was placed in the urethra until it fall off automatically about 3 weeks after operation. One month after operation,the urethral dilatation was done once a week from 1 to 3 months. Result：The koyanagi operations of 30 cases were all successful. Follow-up 1-3 years after operation 3 cases small fistula in coronary ditch（10.0%）,2 cases urethral stricture（6.7%）and 1 case urethral stricture secondary urethrocele were found. One patient need the secondary surgical operation,and others were all cured by expansion rules. Generally the total curing rate in the 30 cases reached 96.7%,and the cosmetic appearance of penis were satisfied and close to the circumcision appearance（without chordee of penis）. Conclusion：The koyanagi operation and tunica vaginalis testis covering technique is an ideal treatment for severe hypospadias because of its satisfied appearance and without any complications.