游离包皮内板卷管尿道成形术矫治尿道下裂的近期观察

SHORT-TERM EFFECTIVENESS OF HYPOSPADIAS REPAIR WITH FREE INNER PREPUCE TUBE

目的探讨游离包皮内板卷管尿道成形术矫治尿道下裂的近期结果,观察游离移植物是否能存活并替代尿道功能。方法 2015年5月-10月,采用游离包皮内板卷管尿道成形术矫治42例尿道下裂。患者年龄1岁1个月～28岁2个月,中位年龄2岁9个月。初次手术41例,尿道下裂术后16个月短尿道致阴茎下曲1例。尿道下裂36例,按尿道海绵体分岔位置分型：阴茎近段型6例、阴茎阴囊交界型1例、阴囊型26例、会阴型3例;无尿道下裂阴茎弯曲畸形按Donnahoo分型,6例为尿道正位开口的Ⅳ型阴茎下曲,其中先天性短尿道2例。结果重建尿道2.0～5.5 cm,平均3.6 cm。患者均获随访,随访时间6～10个月,平均8个月。术后发生尿瘘10例,其中5例于术后3个月内自愈,余5例待后期手术修补;尿道狭窄4例,其中尿道外口狭窄2例,尿道远段狭窄2例,均予以狭窄段切开;创面感染3例,其中2例并发尿瘘（1例未愈,1例自愈）;皮肤缺血坏死3例,其中1例合并感染及尿瘘未愈,另2例创面修复良好;阴囊憩室1例。3例术后阴茎显露不良,其余患者阴茎伸直满意,外观良好。共有10例患者需再手术治疗,总成功率76.2%（32/42）。术后3个月行HOSE评分为11～16分,平均14.7分。22例术后3个月以上门诊复查者检测最大尿流率为1.9～28.4 m L/s,平均10.5 m L/s。结论游离包皮内板卷管成形尿道可存活并替代尿道功能,但近期结果提示并发症发生率较高,须谨慎应用。

Objective To explore the short-term effectiveness of hypospadias repairs with free inner prepuce tube. Methods Forty-two males with hypospadias were repaired with free inner prepuce tube between May and October 2015. The age ranged from 1 year and 1 month to 28 years and 2 months with a median of 2 years and 9 months. Initial operation for hypospadias was performed in 41 cases and re-operation in 1 case of chordee after 16 months of hypospadias repair. There were 36 cases of hypospadias（ 6 cases of proximal penile type, 1 case of penile scrotal type, 26 cases of scrotal type, and 3 cases of perineal type） and 6 cases of type IV chordee according to Donnahoo classification criteria. Results The length of reconstructed urethra was 2.0-5.5 cm（mean, 3.6 cm）. The patients were followed up 6-10 months（mean, 8 months）. Urinary fistulae was noted in 10 patients, which healed spontaneously in 5 cases within 3 months after surgery, and was cured after repair in 5 cases. Urethral stenosis occurred in 4 cases（2 external orifice stricture and 2 distal urethral stricture） and urethral incision was performed. Wound infection was noted in 3 cases, 2 of them needed further surgery for a permanent fistula. Skin ischemic necrosis was found in 3 cases, 1 of them had infection and fistula, and needed further surgical repair. Diverticulum of scrotum developed in 1 case. Ten patients need re-operation, and the success rate was 76.2%（32/42）. At 3 months after surgery, the HOSE score ranged from 11 to 16（mean, 14.7）. The maximum urinary flow rate was 1.9-28.4 m L/s（mean, 10.5 m L/s） in 22 cases of outpatient at 3 months after surgery. Conclusion Free inner prepuce tube can survive and play a role of normal neourethra. The short-term effectiveness has shown a relatively high complication rate and suggests this procedure should be carefully applied.