Snodgrass术式联合口腔黏膜修复尿道下裂

Application of buccal mucosa with Snodgrass procedure for repair of hypospadias

目的报道Snodgrass术式联合口腔黏膜修复尿道下裂的方法及经验。方法 2012年8月—2015年4月,采用Snodgrass术式联合口腔黏膜方法修复55例尿道下裂患儿。患儿年龄1~7岁,平均4岁。其中阴茎远端型32例,阴茎近端型14例,冠状沟型9例。术中将口腔黏膜移植于尿道板黏膜纵行切开创面内,将尿道板黏膜卷管形成尿道。结果患儿均获随访,随访时间3~25个月,平均11个月。术后1例发生尿道感染,并发尿瘘和再造尿道狭窄;5例术后并发尿瘘。其余患儿均排尿通畅,未发生重建尿道和尿道外口狭窄,阴茎矫直完全。结论尿道板纵行切开后创面内移植口腔黏膜能够增加重建尿道材料,相对于传统的Snodgrass术式,降低了重建尿道狭窄发生的风险,并改善了术后阴茎形态。

Objective To present method and experiences in using the buccal mucosa with the Snodgrass procedure for repair of hypospadias. Methods Between August 2012 and April 2015, 55 boys with hypospadias were treated with Snodgrass procedure combined with buccal mucosa. The age ranged from 1 to 7 years（mean, 4 years）. There were 32 cases of distal penile type, 14 cases of proximal penile type, and 9 cases of coronal sulcus type. The buccal mucosa taking from inner cheek was fixed into the incised urethral plate. The urethral plate was tubularized over a catheter.Results All the patients were followed up 3-25 months（mean, 11 months）. After operation, 1 patient had urethral stricture and fistula after repaired urethra was infected, and 5 patients had fistula. For the others, the urination was smooth, the appearance of penis was satisfying, the urethral stricture did not occur, and the penis was straightened completely. Conclusion Compared with traditional Snodgrass procedure, the application of buccal mucosa can increase the reconstruction material of urethral and reduce the stricture of the repaired urethra after operation.