尿道外口前移阴茎头成形术治疗儿童尿道下裂5例

Effect of MAGPI on children suffered from hypospadias

目的报告5例尿道外口前移阴茎头成形术（meatal advancement and glanuloplasty,MAGPI）治疗儿童尿道下裂的手术方法及疗效。方法对2011年7月-2016年1月就诊于我院小儿外科的5例尿道下裂儿童行MAGPI治疗,分析适合于此术式治疗的尿道下裂的解剖学基础及其实质,由此推论该术式适应证的选择、技术细节及并发症的防治。结果 5例接受MAGPI治疗的患儿年龄1~11岁,平均4.37岁。术前均存在阴茎头发育小、扁平,缺乏锥形外观,均存在不同程度的阴茎下屈畸形。行包皮脱套、阴茎腹侧纤维束带松解后,阴茎下屈畸形纠正3例。余2例阴茎头下屈畸形通过白膜紧缩缝合技术得以纠正。阴茎下屈畸形完全纠正后,尿道外口均位于阴茎头隐窝近端或冠状沟,其中4例尿道外口近端的阴茎尿道及海绵体组织发育完善;1例阴茎尿道呈厚膜状且缺乏海绵体组织,尿道外口位于冠状沟,术后出现冠状沟尿瘘。5例患儿术后阴茎均呈伸直状态,排尿通畅;4例尿道外口位于阴茎头隐窝,1例阴茎头腹侧远端吻合口部分裂开、尿道外口退至隐窝近端冠状沟远端,1例冠状沟尿瘘。结论 MAGPI的适应证为阴茎头尿道发育缺陷,对于尿道外口位于阴茎头或冠状沟、阴茎尿道及海绵体组织发育完善者具有良好的疗效;阴茎尿道发育不完善、尿道外口前移阴茎头成形存在张力者,会出现阴茎头腹侧切口裂开及尿瘘等并发症。

Objective To analyze the effect of MAGPI（meatal advancement and glanuloplasty procedure） on children suffered from hypospadias and its clinical applications. Methods Five children who suffered from hypospadias admitted to department of pediatric surgery from July 2011 to January 2016 had undergone MAGPI procedure. The features of anatomical defect and essence of MAGPI were analyzed, and the indication, technique skills and complication preventions of this procedure were suggested. Results The mean age of children who underwent MAGPI procedure was 4.37 years old, ranging from 1 to 11 years old. All patients presented with small size, flattened glans and lacking of typically conical shape of glans, and various degrees of ventral curvature were found. After the penile skin was mobilized as a sleeve back to the base of penile, and the tethering fiber tissues were removed from ventrum of penile, the ventral curvature was corrected in 3 patients. The other 2 patients presented with glan curvature, who underwent tunica albuginea plication resulted in straightness of glans. After complete correction of ventral curvature of the penile, meatus were brought to the proximal of apex of granular groove or coronal groove. All the five patients achieved complete straightness of the penis with straight urinary stream without any difficulty. Meatus were located at the apex of granular groove in 4 cases. Wound dehiscence on the ventrum of penile occurred in one case with developed meatal regression. One patient showed partial split of the ventral anastomosis of the glan, one patient developed coronal fistula, and one patient showed thick membrane-like penile urathrum with the meatus located at coronal groove, and he also developed coronal fistula postoperatively. Conclusion Patients with the following anatomical features should be chosen for MAGPI procedure, including after the correction of ventral curvature of the penis, meatus located at glanular or coronal sites, with well developed penile urethra and corpus spongiosum, or with no tension on suture of glanuloplasty. For patients with defect of glanular urethra, redistribution of glan tissues from dorsal to ventral sites, and simultanenous formation of the glanular urethra, complications like fissuration of abdominal incision of penis or urinary fistula will occur.