睾丸鞘膜覆盖技术在预防不同类型尿道下裂术后尿道瘘中的应用

Application of perididymis covering technique in preventing urethral fistula after various types of hypospadias repairing

目的探讨睾丸鞘膜覆盖技术在预防不同类型尿道下裂术后尿道瘘中的应用。方法回顾性分析河北省保定市儿童医院2009年5月至2016年1月手术治疗的235例尿道下裂患儿的临床资料,按阴茎下弯充分矫正后,分为保留尿道板型和横断尿道板型。其中,保留尿道板型130例,尿道缺损长度范围0.5~2.0 cm,平均长度1.4 cm;尿道板宽度范围0.5~1.0 cm,平均宽度0.7 cm,均采用尿道板纵切卷管成形术(tubularized incised plate,TIP)完成尿道成形,按覆盖方式分为睾丸鞘膜覆盖组(A1组)59例,背侧包皮血管蒂覆盖组(A2组)71例。横断尿道板型105例,尿道缺损长度范围为2.2~5.5 cm,平均长度为3.3 cm,均采用横裁带蒂岛状包皮瓣尿道成形术(Duckett)完成尿道成形,按覆盖方式分为睾丸鞘膜覆盖组(B1组)60例,阴囊肉膜覆盖(B2组)45例。对比分析各类型尿道下裂术后尿道瘘的发生率。结果术后随访时间范围10~51个月,保留尿道板型尿道下裂,A1组出现尿道瘘3例,A2组出现尿道瘘6例,两组尿道瘘发生率比较,差异无统计学意义(P>0.05)。横断尿道板型尿道下裂,B1组出现尿道瘘3例,B2组出现尿道瘘9例,两组尿道瘘发生率比较,差异有统计学意义(P<0.05)。结论在保留尿道板型尿道下裂采用TIP术式应用睾丸鞘膜覆盖技术没有明显减少尿道瘘的发生;在横断尿道板型尿道下裂采用Duckett手术方式应用睾丸鞘膜覆盖技术可以减少尿道瘘的发生,是一种覆盖方式的选择。

Objective To explore the application of perididymis covering technique in preventing urethral fistula after various types of hypospadias repairing. Methods From May 2009 to January 2016, 235 cases of hypospadias were retrospectively analyzed. After correcting chordee, they were divided into two groups of retaining urethral plate (n=130, A) and transversing urethral plate (n=105, B). In group A, urethral defect had an average length of 1.4(0.5-2.0) cm while urethral plate had an average width of 0.7(0.5-1.0) cm. Tubularized incised plate (TIP) urethroplasty was performed. Based upon covering method, group A was further divided into the sub-groups of perididymis covering (A1, n=59) and foreskin vascular pedicle covering (A2, n=71);In group B, urethral defect had an average length of 3.3(2.2-5.5) cm. Transverse preputial island flap urethroplasty (Duckett) was performed. Group B was further divided into the sub-groups of perididymis covering (B1) and scrotal dartos covering (B2). The incidence of urethral fistula was compared after different types of hypospadias repairing. Results During a follow-up period of 10-51 months, urethral fistula occurred in group A1 (n=3) and group A2 (n=6) after retaining urethral plate. No inter-group statistically significant difference existed in the incidence of urethral fistula (P>0.05). And urethral fistula occurred in group B1 (n=3) and group B2 (n=9) after transversing urethral plate. Significant inter-group differences existed in the incidence of urethral fistula (P<0.05). Conclusions Perididymis covering technique can not significantly reduce the occurrence of urethral fistula during TIP urethroplasty after retaining urethral plate while Duckett urethroplasty after transversing urethral plate can.