睾丸鞘膜覆盖对减少尿道下裂再手术后尿道皮肤瘘的效果分析

Efficacy of tunica vaginalis as anti-fistula coverage during redo hypospadias repair

目的比较在尿道下裂再手术病例中睾丸鞘膜与其他软组织覆盖对防止尿道皮肤瘘的疗效影响。方法回顾性分析2010年9月至2014年4月于本院进行尿道成形和尿瘘修补治疗的尿道下裂再手术患者226例,年龄2岁1个月至34岁9个月(平均年龄9岁5个月)。95例远段尿道裂开,107例尿瘘,28例尿道狭窄,24例尿道憩室,23例残留阴茎下曲,52例为分期手术一期术后。术中未采用软组织覆盖18例,阴囊肉膜瓣覆盖46例,阴茎皮下筋膜瓣覆盖74例,邻近软组织覆盖35例,睾丸鞘膜覆盖53例。术后留置尿管5~14d,随访24~67个月。结果无软组织覆盖组中,5例出现尿瘘(27.8%),阴囊肉膜瓣覆盖组7例出现尿瘘(15.2%),阴茎皮下筋膜瓣覆盖组7例尿瘘(9.5%),以邻近软组织覆盖组4例尿瘘(11.4%),睾丸鞘膜覆盖组中2例出现尿瘘(3.8%)。运用卡方检验对各组进行比较,尿瘘发生率的差异存在统计学意义(x^2=6.978,P=0.008),各组间两两比较,睾丸鞘膜组与无软组织覆盖组间(x^2=8.589,P=0.003)、睾丸鞘膜组与阴囊肉膜组间(x^2=3.863,P=0.049),带蒂筋膜组与无组织覆盖组间(x^2=4.237,P=0.004)差异有统计学意义,其余组间差异统计学意义。结论尿道下裂治疗中应强调对成形尿道进行软组织覆盖,睾丸鞘膜较其他常用软组织能够更有效减少尿道下裂再手术后尿道皮肤瘘的发生几率。

Objetive To compare the efficacy of tunica vaginalis flap versus other soft tissues as neoure-thral coverage during redo hypospadias repair.Methods From September 201 0 through April 201 4,226 redo cases of hypospadias were treated with urethral dehiscence （n =95）,urethrocutaneous fistula （n =1 07）,ure-thral stenosis （n =28）,urethral diverticulum （n =24）,urethral tethering（n =23）and staged repair （n =52）. Their average age was 1 1 3 （25 -41 7）months.According to coverings,they were divided into 5 groups,i.e. group A without coverage （n =1 8）,group B with scrotal dartos flap （n =46）,group C with prepucial fascia （n=74）,group D with adjacent fascia （n =35）and group E with tunica vaginalis flap （n =53）.A urethral stent provided urinary diversion for 5 to 1 4 days.The follow-up period was 24 to 67 months.Results In group A,5 /1 8 （27.8%）developed urethrocutaneous fistula.The incidence of fistula was 1 5.2% （7 /46）,9.5%（7 /74） and 1 1 .4%（4 /35）in groups B,C and D respectively.In group E,there were significantly fewer urethrocutane-ous fistulas （2 /53,3.8%）as compared to other groups.The inter -group differences were statistically signifi-cant in fistula rate （χ2 =6.978,P =0.008）.And the inter-group differences between group A ＆amp; E （χ2 =8.589,P =0.003）,group B ＆amp;E （χ2 =3.863,P =0.049）and group A ＆amp;C （χ2 =4.237,P =0.004）had statistical significances. Conclusions Tunica vaginalis flap reduces fistula rate and it is superior to other cov-erage as a waterproofing layer for preventing fistula during redo hypospadias repair.