横行包皮岛状带蒂皮瓣两种不同转移途径治疗儿童尿道下裂的对比分析

Two different routes for transferring the pedicled preputial island flap for hypospadias in children: A comparative analysis

目的:通过分析包皮岛状带蒂皮瓣的两种不同转移途径的操作特点及疗效差异,总结尿道下裂手术操作经验。方法:回顾性分析2015年7月至2017年12月我科采用包皮岛状带蒂皮瓣的122例首次尿道下裂手术病例,根据包皮带蒂皮瓣转移途径分为两组,对照组采用阴茎体单侧面途径转移包皮皮瓣80例,观察组经血管蒂中间孔途径转移包皮皮瓣42例。观察两组疗效。结果:与对照组比较,观察组手术时间延长[(164.43±25.03) min vs(134.71±32.37) min,P<0.01];但导尿管保留时间缩短[(2.93±0.97)周vs(3.68±0.73)周,P<0.01]。两组新建尿道长度无统计学差异[(2.86±0.71) cm vs(2.83±0.82) cm,P=0.863]。术后随访6~12个月,观察组术后总并发症发生率低于对照组(9.52%vs 25.00%,P=0.041)。结论:经血管蒂中间孔途径转移包皮带蒂皮瓣术虽然手术时间有所延长,但是术后尿管保留时间短、并发症发生率低,值得推广。

Objective: To summarize the experience in the surgical treatment of hypospadias by analyzing the operation features and clinical effects of two different routes for transferring the pedicled preputial island flap. Methods: This retrospective study included 122 cases of hypospadias treated by transferring the pedicled preputial island flap, 80 from one side of the penis(the control group) and the other 42 through the middle orifice of the vascular pedicle(the observation group). We recorded the intra-and postoperative data and compared them between the two groups. Results: The operation time was significantly longer in the observation group than in the control([164.43 ± 25.03] vs [134.71 ± 32.37] min, P < 0.01), but the catheter-indwelling time was dramatically shorter in the former than in the latter group([2.93 ± 0.97] vs [3.68 ± 0.73] wk, P < 0.01). There was no statistically significant difference in the length of the reconstructed urethra between the two groups([2.86 ± 0.71] vs [2.83 ± 0.82] cm, P = 0.863). A 6-to 12-month follow-up showed a significantly lower incidence of postoperative complications in the observation than in the control group(9.52% vs 25.00%, P < 0.05). Conclusion: Transferring the pedicled preputial island flap through the middle orifice of the vascular pedicle, though taking a longer time than that from one side of the penis, has the advantages of a shorter catheter-indwelling time and a lower incidence rate of postoperative complications, and therefore deserves wide clinical application.