游离包皮内板卷管尿道成形术治疗重型尿道下裂的临床疗效分析

Clinical analysis of severe hypospadias repair with free inner prepuce tube

目的:探讨采用游离包皮内板卷管尿道成形治疗重型尿道下裂的近期疗效。方法:2016年6月~2018年6月我院诊治的58例重度尿道下裂患儿,年龄8个月~6岁2月,中位年龄1岁3个月。均为初次手术,包括会阴型15例、阴囊型25例、阴茎阴囊型18例。合并其他畸形包括,隐睾8例10侧,腹股沟斜疝5例,阴茎阴囊转位35例。手术采用游离包皮内板卷管重建尿道。观察患儿术后近期并发症情况、尿流率和HOSE评分。结果:58例手术均一期完成,重建尿道2.8~7.3 cm,平均3.9 cm;同时完全矫正阴茎阴囊转位、阴茎显露不良、隐睾和斜疝;患儿随访时间9~24个月,平均13个月。术后6个月随访阴茎伸直满意,外观满意。31例完成尿流率检查,最大尿流率4.6~12.9 mL/s,平均8.4 mL/s。HOSE评分为13~16分,平均15.2分。并发症方面,术后发生尿瘘5例;阴囊感染1例,尿道狭窄4例。阴茎显露不良4例。一次手术成功率84.5%(49/58)。2例尿瘘患儿术后半年以上行尿瘘修补术获得成功,4例尿道狭窄早期行尿道扩张或留置尿管后未再狭窄。结论:游离包皮内板卷管尿道成形术治疗重度尿道下裂可获得较好的近期疗效。

Objective: To investigate the short-term effect of free inner prepuce tube in the treatment of severe hypospadias. Method: From June 2016 to June 2018, 58 children with severe hypospadias were treated in our hospital. The age ranged from 8 months to 6 years, and the median age was 1 year and 3 months. All were primary operations, including 18 cases of penile scrotum, 25 cases of scrotum, and 15 cases of perineal. Patients were found complicated by other malformations including 35 cases of obvious penile scrotum transposition, 8 cases 10 sides of cryptorchidism, and 5 cases of inguinal hernia. The operation used a free foreskin inner tube to rebuild the urethra, and the first stage of the combined malformation was corrected at the same time. The postoperative complications, urine flow rate and HOSE score were observed. Result: Operations of 58 cases were completed in one stage, and the urethra was reconstructed 2.8-7.3 cm, with an average of 3.9 cm. At the same time, the penile scrotum transposition, penile exposure, cryptorchidism and oblique hernia were completely corrected. The children were followed up for 9-24 months, with an average of 13 month. At 6 months after operation, the penis was satisfactory and the appearance was satisfactory. Thirty-one patients completed a urine flow rate test with a maximum urine flow rate of 4.6-12.9 mL/sec with an average of 8.4 mL/sec. The HOSE score was 13 to 16 points with an average of 15.2 points. In terms of complications, 5 cases of urinary fistula, 1 case of scrotal infection, 4 cases of urethral stricture and 4 cases of poor penile exposure occurred after operation. The success rate of one stage operation was 84.5%(49/58). Two children with urinary fistula had successful urinary fistula repair more than half a year after surgery. Conclusion: The treatment of severe hypospadias with free foreskin tube urethroplasty can obtain good short-term results.