尿道板重建分期卷管尿道成形术在初治重型尿道下裂中的应用

Urethral plate reconstruction and staged tubularization-urethroplasty in the repair of primary severe hypospadias

目的 总结尿道板重建分期卷管尿道成形手术的治疗经验。方法 分析2010年9月至2015年3月于我院进行尿道板重建分期卷管尿道成形手术的初治患者55例,其中会阴型32例,阴囊性23例。55例分期手术患者32例完成第二期手术,第二期手术采用尿道板纵切卷管尿道成形（TIP）手术4例,采用原位尿道板卷管尿道成形（Duplay）手术28例。术后安置尿管9~11天,随访18~68个月。结果 55例患者第一期手术后1例出现尿瘘（1.81%）,1例出现尿道裂开（1.81%）,无尿道狭窄、尿道憩室等其他并发症。32例完成第二期手术,其中1例出现阴茎头裂开（3.12%）,3例出现瘘（9.37%）,1例出现狭窄（3.12%）,1例出现尿道裂开（3.12%）,总并发症发生率为18.75%。结论 尿道板重建分期卷管尿道成形手术较易掌握,并发症发生率低,外观较好,值得在更大范围内推广和应用。

Obej ctive To summarize the therapeutic experience of urethral plate reconstruction and staged tubularization -ure-throplasty.Methods We retrospectively reviewed 55 patients treated with urethral plate reconstruction and staged tubularization ure-throplasty from September 2010 through March 2015 in our hospital.Of the 55 patients,23 patients were scrotal type of hypospadias and 32 were perineal type of hypospadia .Moreover,32 had completed the stage II repair in which 4cases had TIP repair while 28 had Du-play repair .Urine tube was placed for 9 ~11 day after operation .The patients were followed up from 18 months to 68 months with an average of 38 months.Results After stage I repair, there was no urethrostenosis ,urethral diverticulum or other complications except one case with urinary fistula （1.81%）.After stage II repair in 32 patients,there was one case with penis head split （3.12 %）,3 uri-nary fistula （9.37%）,1 urethrostenosis （3.12%） and 1 urethral opening crack （3.12%）.The total rate of complications was 18.75%.Conclusion Urethral plate reconstruction and staged tubularization-urethroplasty can be practiced easily and its complication rate is low with good cosmesis .It is worth for promotion and wilder application .