应用舌黏膜修复多次手术失败的尿道下裂的疗效研究

Repairing hypospadias using lingual mucosa after multiple failed surgical procedures

目的探讨应用舌黏膜修复和重建多次手术失败的尿道下裂的疗效。方法选取2013年1月至2016年12月在本院就诊的经手术修复2次以上失败的23例尿道下裂患儿作为研究对象,所有患儿采用舌黏膜重建尿道,观察其疗效及相关并发症。所有患儿术后随访6～24个月,以排尿通畅、阴茎伸直满意、外观良好、至少连续6个月以上不需要扩张尿道为随访终点。结果 23例均一期完成手术,15例一期治愈,排尿畅通,5例出现尿道狭窄,经过3～6个月尿道扩张后治愈,3例因感染导致移植舌黏膜部分坏死出现尿道瘘,半年后再次行尿道瘘修补术痊愈。结论对于多次手术失败的尿道下裂患儿,应用舌黏膜重建尿道,疗效肯定,手术方法简单,取材容易,有临床推广价值。

Objective To explore the efficacies and complications of using periglottis for reconstructingurethral repair of hypospadias after multiple surgical failures. Methods From January 2013 to December2016,after multiple failed hypospadias surgeries,23 patients urethras were reconstructed with periglottis for observing the efficacies and complications. Followups were conducted for 6 - 24 months. The endpoints includedvoiding wi th a decent stream,adequate penile straightening,satisfactory penile appearances and no need of urethral expansion for 6 consecutive months. Results All surgeries were primarily completed. Among them,15were cured and could void with a decent stream,5 cases of urethrostenosis recovered after 3 - 6 months of urethral expansion and 3 cases of urethral fistula due to partial necrosis of implanted periglottis caused by infectionwere repaired at 6 months. Conclusion Using periglottis for urethral reconstruction is simple and efficaciousfor hypospadias after multiple surgical failures. Clinical popularization is recommended.