包皮重建在远端型尿道下裂中的应用

Distal hypospadias repairing with foreskin reconstruction

目的 探讨包皮重建在尿道板纵切卷管术(tubularized incised plate, TIP)治疗远端型尿道下裂中的临床应用价值。方法 回顾性分析2017年11月至2018年4月收治的应用TIP术式治疗的64例远端型尿道下裂患儿的临床资料。其中28例行包皮重建(包皮重建组),36例行包皮环切(包皮环切组)。比较两组手术时间、术后并发症发生率及再手术率的差异。结果 包皮重建组手术时间为(109.9±2.2)min,较包皮环切组(143.8±3.0)min明显缩短,组间比较,差异有统计学意义(P<0.000 1)。包皮重建组术后发生尿道并发症2例(7.1%),包括尿瘘1例和尿道外口狭窄1例;包皮环切组术后发生尿道并发症4例(11.1%),包括尿瘘1例、阴茎头裂开2例和尿道外口狭窄1例,两组尿道并发症发生率比较,差异无统计学意义(P=0.688)。包皮重建组术后出现重建包皮裂开2例(7.1%),包皮环切组术后有1例(2.8%)出现阴茎向一侧扭转约30°,两组皮肤并发症发生率比较,差异无统计学意义(P=0.577)。包皮重建组再手术3例(10.7%),包括尿瘘修补1例和包皮环切2例;包皮环切组再手术3例(8.3%),包括尿瘘修补1例和远端尿道及阴茎头成形2例,两组再手术率比较,差异无统计学意义(P=0.746)。结论 TIP治疗远端型尿道下裂时行包皮重建手术简单易行,与包皮环切组相比没有增加术后并发症的发生率及再手术率,且因保留了包皮,可以更好的隐匿阴茎畸形,同时为术后发生并发症再次手术提供了有利条件。因此在行TIP修复远端型尿道下裂时,可根据包皮条件及患儿家长的意愿选择进行包皮重建手术。

Objective To evaluate the efficacy of foreskin reconstruction for distal hypospadias during tubularized incised plate(TIP)repairing.Methods From November 2017 to April 2018,64 children with distal hypospadias underwent stented TIP urethroplasty.Foreskin reconstruction(n=28)and circumcision(n=36)were performed and compared with regards to operative duration and postoperative complications.Results The operative duration was[(109.9±2.2)vs.(143.8±3.0)]min in foreskin reconstruction and circumcision groups respectively(P<0.0001).Urethroplasty complications occurred in 4(11.1%)circumcision children(fistula,n=1;glans dehiscences,n=2;meatal stenosis,n=1)versus 2(7.1%)after prepucioplasty(fistula,n=1;meatal stenosis,n=1)(P=0.688).Skin complications included preputial dehiscences(n=2,7.1%)in foreskin reconstruction group and penile torsion(n=1,2.8%)in circumcision group(P=0.577).The reoperative rate was 10.7%(3/28)in foreskin reconstruction group including fistula repair(n=1)and circumcision(n=2)for foreskin dehiscence versus 8.3%(3/36)in circumcision group including fistula repair(n=1)and glansplasty(n=2)(P=0.746).No significant inter-group differences existed in urethroplasty and skin complications or reoperative rate.Conclusions During TIP repairing,foreskin reconstruction is a time-saving procedure with similar complication and reoperative rate to traditional technique.Prepuce preservation may hide most penile malformations and provide valuable local tissues for dealing with potential complications.Foreskin reconstruction is a surgical alternative for distal hypospadias using TIP repair based upon prepuce appearance and parental preference.