横行带蒂岛状包皮瓣尿道成形造瘘术分期矫治尿道下裂

Duckett URETHROPLASTY-URETHROTOMY FOR STAGED HYPOSPADIAS REPAIR

目的 探讨横行带蒂岛状包皮瓣尿道成形造瘘术分期矫治尿道下裂的临床效果。方法 2013年8月-2014年9月,收治53例分期矫治尿道下裂患者。患者年龄10个月~24岁3个月,中位年龄1岁10个月。阴茎近段型5例,阴茎阴囊交界型2例,阴囊型36例,会阴型10例。第1次手术采用单纯横行带蒂岛状包皮瓣（27例）或联合尿道板瓣（26例）重建尿道,吻合口腹侧不予以缝合,与外层皮肤缝合成形尿道皮肤瘘口;1年后第2次手术行瘘修补。结果 重建尿道长度2~8 cm,平均3.6 cm。第2次手术后患者均获随访,随访时间5~17个月,平均8个月。第1次手术后发生其他部位尿瘘3例,皮瓣坏死1例,旷置尿道阴茎头段狭窄2例,残留阴茎弯曲1例;第2次手术后发生尿瘘2例,轻度尿道憩室2例,补瘘部位外周瘢痕压迫致轻度狭窄1例。第2次手术后3个月HOSE评分为12~16分,平均14.5分。32例于第2次手术后3~14个月检测最大尿流率为3.9~22.7 m L/s,平均8.6 m L/s。结论 横行带蒂岛状包皮瓣尿道成形造瘘术可作为分期矫治尿道下裂的一种选择,手术安全性高,并发症发生率低,外观满意。

Objective To explore the surgical outcome of Duckett urethroplasty-urethrotomy for staged hypospadias repair. Methods Fifty-three patients with hypospadias were treated by 2 stages between August 2013 and September 2014. The age ranged from 10 months to 24 years and 3 months （median, 1 year and 10 months）. There were 5 cases of proximal penile type, 2 cases of penoscrotal type, 36 cases of scrotal type, and 10 cases of perineal type. Urethroplasty was performed with tubed transverse preputial island flap only in 27 cases or combined with urethral plate in the other 26 cases, thus a urethrocutaneous fistula was intentionally created; stage Ⅱ fistula repair was carried out at 1 year after stage I repair. Results The length of the new urethra ranged from 2 to 8 cm with an average of 3.6 cm. The patients were followed up 5-17 months with an average of 8 months after stage Ⅱ repair. After stage I repair, urethral fistula was noted at other site in 3 cases, skin necrosis in 1 case, glandular stricture in 2 cases, cicatric curvature in 1 case, and position and morphology of urethral orifice not ideal in 4 cases. After stage II repair, urethral fistula was noted in 2 cases, mild urethral diverticulum in 2 cases, and stricture at temporary repair site in 1 case. HOSE score was 12-16 at 3 months after stage II repair （mean, 14.5）. At 3-14 months after stage Ⅱ repair, the maximum flow rate ranged from 3.9 to 22.7 mL/s with an average of 8.6 mL/s. Conclusion Duckett urethroplasty-urethrotomy can be used as staged repair for primary treatment ofhypospadias because of high safety, low complication incidence, and satisfactory appearance.