尿道下裂术后再手术单中心8年随访经验

An 8-year follow up of redo hypospadias repairs

目的：随访分析我院单中心8年治疗尿道下裂术后再手术患者的经验与得失。方法：回顾性分析2007年6月至2015年12月在我院治疗的43例尿道下裂术后失败后再次手术的患者，综合考虑患者年龄、原先手术次数、尿道开口位置、再次手术方式、手术时间与术后并发症，患者随访时间3~99月（平均52.3月）。结果：患者手术年龄32~212月（平均90.6月），20例患者原先有1次手术史、12例2次手术史、9例3次手术史、2例病患经历4次手术。在以上患者中，21例行口腔粘膜镶嵌式尿道成形术、9例行Onlay手术、13例行TIP术式成形尿道。术后尿道瘘4例、尿道狭窄3例、术后血肿1例、阴茎弯曲1例与皮瓣坏死1例，并发症发生率23.3%。结论：尿道下裂术后失败患者再次手术的策略往往取决于患者局部可利用材料多寡与原术后疤痕的严重程度，口腔黏膜镶嵌式尿道成形技术可适用于腹侧尿道重建材料缺乏的患者，但是仍需要长期随访再次手术患者的尿道顺应性与残余弯曲情况。

Objective：To report our 8-year follow up for redo hypospadias repair. Methods：A total of 43 patients with previous failed hypospadias repair were included in our study. Patients’ data were analyzed regarding age, number of previous repairs, meatal location, procedure performed, operative time and complications. Patients were followed up for 3 to 99 （mean 52.3） months. Results：Patient age ranged from 32 to 212 （mean 90.6） months. Twenty patients had a single previous hypospadias repair, 12 had two previous repairs, 9 had three repairs and 2 had four previous repairs. Of the 43 patients, 21 underwent oral mucosal gratf urethroplasty, 9 Onlay island lfap and 13 tubularized incised plate urethroplasty. Complications were encountered in 10 （23.3%） patients, including 3 urethral stricture, 4 urethra-cutaneous ifstula, 1 bleeding, 1 penis curve, and skin disruption in 1. Conclusion：Decision making in redo hypospadias surgery mainly depends on local tissue availability and the degree of tissue scarring. hTe characteristics of oral mucosal gratf make it suitable for urethroplasty in the absence of local donor tissues. A long-term follow up for redo hypospadias repair is required to assess the late neourethral stricture and residual penile curvature.