Onlay－tube－onlay术式一期治疗重度尿道下裂的临床应用

Onlay-tube-onlay urethroplasty used for one-stage repairing of severe hypospadias

目的：分析Onlay－tube－onlay术式一期治疗重度尿道下裂的随访结果，探讨该术式的临床应用价值。方法回顾性分析2012年5月至2014年10月收治的32例应用Onlay－tube－onlay术式一期治疗重度尿道下裂患儿的临床资料。患儿年龄7个月-13岁7个月，平均年龄2．8岁，尿道口位于阴茎根部或为阴囊型重度尿道下裂，均为首次手术。术中脱套并横断尿道板（必要时行背侧白膜紧缩）完全矫直阴茎下曲后测得尿道缺损长度3．0-5．0 cm，平均（4．0±0．5） cm，根据测得尿道缺损长度留取背侧包皮内板岛状皮瓣（两端皮瓣较中间皮瓣窄），转移至腹侧置于尿道开口和阴茎头之间，将背侧岛状包皮瓣中间卷管，远近端加盖于横断尿道板两端成形尿道。术后留置F8导尿管，术后12 d拔管出院。结果术后随访6个月至2年11个月，平均随访时间2年1个月，其中尿瘘2例（6．25％），尿道狭窄3例（9．37％），无尿道憩室病例发生。术后阴茎体外观满意，尿道口外形裂隙状，尿线满意，尿流率检查提示尿流曲线多数成钟形或高平台形。最大尿流率（8．56±3．99） ml／s，平均尿流率（5．23±2．32）ml／s。结论 Onlay－tube－onlay术式是Onlay术式和Duckeet术式的结合，术后尿道瘘、尿道狭窄、尿道憩室等并发症发生率低，同时避免了完全保留尿道板使得阴茎体无法完全矫直或因过分依赖背侧白膜紧缩致阴茎体呈短粗型影响外观。 Onlay－tube－onlay治疗重度尿道下裂的临床应用效果满意，可以作为一期治疗重度尿道下裂的方案之一。

Objective To retrospectively analyze the efficacy of Onlay-tube-onlay urethroplasty used for one-stage repairing of severe hypospadias.Methods From May 2012 to October 2014, a total of 32 patients with severe hypospadias who underwent primary HR at Nanjing Medical University Affiliated Children Hospital were enrolled.Urethral opening was located in the penis and scrotum, and onlay-tube-onlay urethroplasty was performed in the patients who had severe penile curvature even after skin degloving. The average age was 2.8 years （7 months-13 years and 7 months）, postoperative follow-up was 2 years and 1month on average （ 6 months -2 years and 11 months ）, and clinical data including appearance, complications and uroflowmetry were documented.Results All of 32 surgeries were completed by one experienced pediatric urologist, and the urethral defect length was measured after penile curvature completely corrected.The postoperative complications included two cases of urinary fistula （ 6.25%） and 3 cases of urethral stricture （9.37%）.Two cases of fistula were cured by one operation.Stricture of urethral external orifice was relieved after urethral dilation in 1 case, and another 2 cases underwent another operation.The straightening and appearance of penis were satisfactory and meatus was located at normal anatomical position postoperatively.Uroflow was shaped into bell or high platform.Conclusions Onlay-tube-onlay urethroplasty is a combination of Onlay and Duckeet surgery, with low complication rates.Fully stripping and preserving urethral plate decrease the occurrence of complications, especially stricture. Urethral plate transecting permitted penile straightening completely.Onlay-tube-onlay can be a good option for the patients with severe＆amp;nbsp;hypospadias.