包皮内板血管蒂覆盖技术在Snodgrass术修复尿道下裂中的应用

Application of inner vascular pedicle cover technique in Snodgrass repair of hypospadias

目的：评估应用包皮内板血管蒂组织覆盖技术对Snodgrass术修复尿道下裂患儿的手术效果，以改进Snodgrass术式。方法2014年3月至2015年6月应用Snodgrass术式一期修复尿道下裂患儿76例，其中冠状沟型12例，阴茎体型48例，阴茎阴囊型16例。将76例患儿分为两组，其中A组（24例）单纯行Snodgrass术式尿道成形术，B组（52例）应用包皮内板血管蒂组织转移覆盖新成形段尿道。术后复查随访3~6个月，观察比较两组术后尿道瘘、尿道狭窄等主要并发症的发生率。结果 A、B两组患儿分别出现尿道瘘4例（16.67％）、3例（5.77％），并发尿道狭窄2例（8.33％）、4例（7.69％），B组出现术后阴茎包皮皮瓣缺血2例（3.85％）。两组患儿尿道瘘发生率比较差异有统计学意义（P﹤0.05），尿道狭窄发生率比较差异未见统计学意义（P﹥0.05）。结论 Snodgrass术式尿道成形术中应用转移包皮内板血管蒂组织至腹侧覆盖新成形段尿道，可有效减少术后尿道瘘的发生率。

Objective To evaluate the surgical effect of covering internal preputial vesel pedicle for hypospadias repair with Snodgrass urethroplasty and to improve the Snodgrass. Methods The 76 ca-ses by Snodgrass operation first-stage repair of hypospadias from March 2014 to June 2015 ,including 12 cases of coronal shape channel,48 cases of the body of the penis,16 cases of penoscrotal type;Seventy-six cases were divided into two groups,group A（24 cases）underwent Snodgrass urethra angioplasty, group B（52 cases）with the inner prepatial in vascularized tissue transfer covering new forming urethra. Postoperative follow-up for three to six months,the incidence of major postoperative complications such as urethral fistula and urethral stricture were observed and compared between the two groups. Results Af-ter surgery,four cases（16. 67%）of urethral fistula in group A,three cases（5. 77%）in group B,and there were two cases（8. 33%）of meatus in group A,four cases（7. 69%）in group B. There were two cases（3. 85%）of the penis foreskin flap after operation in group B. There was a significant difference in the incidence of urethral fistula between the two groups（ P﹤0. 05 ）,there was no significant difference in the incidence of urethral stricture between the two groups（ P﹥0. 05 ）. Conclusions Covering internal preputial vessel pedicle for hypospadias repair with Snodgrass,can effectively reduce the incidence of postoperative urethral fistula.