尿道海绵体联合周围筋膜组织整体覆盖技术在尿道板纵切卷管手术中的疗效观察

Integral Covering Technique of Corpus Spongiosum Combined with Deep Fascia of Penis in Tubularized Incised Plate(TIP) Urethroplasty for Hypospadias and Curative Effect Observation

【目的】观察一种新的尿道海绵体联合周围筋膜组织整体覆盖技术改良的尿道板纵切卷管术(TIP),并与常规TIP术比较其手术效果。【方法】2016年2月-2017年11月对40例初次尿道下裂患儿应用TIP术修复。以门诊单双号分为A、B两组。A组共23例患儿,其中冠状沟型9例,阴茎体型11例,阴茎阴囊型3例,采用一种新的改良覆盖技术:将尿道板两侧分叉的尿道海绵体,连同周围筋膜组织及阴茎头两翼在阴茎体表面向外侧游离并在中线处缝合,覆盖新成形尿道。B组17例患儿,冠状沟型6例,阴茎体型11例,采用常规的TIP手术。术后随访6~27个月,记录两组并发症和术后外观情况,并进行统计学分析。【结果】40例患儿均顺利完成手术。A、B两组患儿年龄组成、住院时间、拆除敷料和拔除导尿管时间均无统计学差异。A组有12例伴有阴茎下弯(52%),B组有10例伴有阴茎下弯(58.8%),均采用了海绵体背侧白膜折叠术纠正。A、B两组患儿手术时间分别为(104.8±24.1)min和(94.5±23)min,成形尿道长度分别为(2.1±0.7)cm和(1.9±0.6)cm,差异均无统计学意义(P> 0.05)。经过随访,A组出现尿瘘合并尿道口狭窄1例(4.3%)。B组出现尿瘘2例(11.8%),其中1例合并尿道口狭窄1例(5.9%),尿道外口下移1例(5.9%),两组均无尿道裂开及尿道憩室病例。所有病例未观察到残留阴茎下弯。两组并发症发生率比较差异无统计学意义(P> 0.05)。【结论】尿道海绵体联合周围组织整体覆盖技术改良的TIP术治疗儿童尿道下裂操作简单,疗效确切。

【Objective】To report a new Integral covering technique of corpus spongiosum combined with deep fascia of penis in tubularized incised plate(TIP)urethroplasty for hypospadias,the results were compared with the conventional TIP procedure.【Methods】From Feb.2016 to Nov.2017,40 cases of primary hypospadias were repaired with TIP urethro-plasty.The patients were divided into 2 different groups by odd and even outpatient service numbers.Group A:23 pa-tients(9 in subcoronal,11 in midshaft,3 in penoscrotal)underwent modified one-stage TIP urethroplasty using a new covering technique.The“Y”-shaped bifurcation corpus spongiosum with the deep fascia of penis and the glans were pre-served and lateral anatomy at the Buck fascia,longitudinal suture of it to cover the top of the forming urethra.Group B:17 patients(9 in subcoronal,11 in midshaft)underwent conventional TIP procedure.Followed by 6~27 months,the postoperative appearance and complications were recorded and for statistical analysis.【Results】40 operations were suc-cessful.There was no statistically significant difference in age,postoperative hospital stay,time of removal the dressing and catheter between two groups(P>0.05).12 patients(52%)in Group A and 10(58.8%)in Group B had a severe chordee that was corrected with dorsal plication.The mean operative time of Group A and Group B was(104.8±24.1)min and(94.5±23)min,the mean length of the urethroplasty was(2.1±0.7)cm and(1.9±0.6)cm,and there was no statistically significant difference in 2 groups.After follow-up,only 1 case of the urethrocutaneous fistulae combined with the meatal stenosis(4.3%)in Group A.There were 2 cases of the urethrocutaneous fistulae(11.8%)in Group B,1 case combined with the meatal stenosis(5.9%).Another 1 case of glans dehiscence occurred in Group B.No urethral dehiscence and urethral diverticulum in both groups was recorded.No residual chordee was observed in any cases.There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).【Conclu-sion】The new technique of Integral covering of corpus spongiosum combined with deep fascia of penis in tubularized in-cised plate(TIP)urethroplasty is simple and effective.