Duckett术治疗重度尿道下裂单中心效果观察

A single-center observation on the effect of Duckett′s procedure in the treatment of severe hypospadias

目的探讨Duckett术重建尿道修复重度尿道下裂的疗效及并发症。方法回顾性分析行Duckett手术方式Ⅰ期修复重建尿道的重度尿道下裂患者997例的临床资料。结果Duckett术Ⅰ期修复尿道997例,1期治愈708例,治愈率为71.01%。发生尿道狭窄241例,尿道狭窄发生率为24.17%,狭窄程度较轻229例,局部麻醉下间断尿道扩张后成功解决排尿困难;尿道扩张失败9例,全身麻醉下通过尿道内口逆行扩张尿道,保留尿管,拔除尿管后再次间断尿道扩张成功解决排尿困难;发生尿道感染、坏死,后尿道闭锁3例,全身麻醉下敞开狭窄段尿道,6个月后再次行snodgrass纵行卷管术重建尿道后可通畅排尿。发生尿道瘘45例,尿道瘘发生率为4.51%,瘘口较小患儿,再次保留尿管引流尿液,瘘口处涂抹表皮生长因子,最终治愈5例;瘘口无法自愈患儿38例,半年后通过尿道瘘修补术成功解决;再次出现尿道瘘2例,再次行尿瘘修补术成功解决。发生尿道憩室3例,尿道憩室发生率为0.30%,憩室较大2例,影响排尿,重新成形憩室部尿道治愈;憩室较小1例,暂不处理,定期随访。所有患儿随访6~36个月,观察终点为能够通畅排尿,持续3个月不需要尿道扩张。结论Duckett术Ⅰ期修复重建重度尿道下裂患儿缺损尿道,手术效果满意,临床并发症可通过相应方法矫治,具有临床推广价值。

Objective To summarize the effect and complications of Duckett′s procedure to repair and reconstruct the urethra in the treatment of severe hypospadias.Methods A retrospective analysis was performed on the clinical data of 997 patients with severe hypospadias who underwent Duckett′s procedure to repair and reconstruct the urethra.Results A total of 997 cases underwent Duckett′s procedure of one-stage urethroplasty to reconstruct the urethra,and 708 patients were cured(the cure rate was 71.01%).There were 241 cases suffering urethral stricture,with an incidence of 24.17%,of whom 229 cases whose urethral stricture was mild were able to maintain unobstructed urine flow after intermittent urethral dilatation under local anesthesia.Nine patients experienced unsuccessful urethral dilatation,and then under general anesthesia,the urethra was expanded retrogradely through the internal orifice of the urethra,and the catheter was retained.After removing the urinary tube,intermittent urethra dilatation was performed to successfully solve the dysuria.There were 3 cases of urethral atresia after urinary tract infection and necrosis.The narrow segment of the urethra was opened under general anesthesia.Six months later,the urethra was reconstructed by snodgrass longitudinal rolling tube operation to allow smooth urination.Forty-five cases of urethral fistula occurred,with an incidence of 4.51%.For children with a small fistula,the urethra was retained again to drain urine,epidermal growth factor was applied to the fistula,and 5 cases were cured.Another 38 children with fistula could not heal themselves,and six months later,it was successfully resolved by urethral fistula repair.Two cases of urethral fistula reoccurred,and the urethral fistula was successfully resolved again by urethral fistula repair.There were 3 cases of urethral diverticulum,with an incidence of 0.30%;2 cases had large diverticulum,which affected urination,and the urethra was cured by re-forming the diverticulum;1 case who had small diverticulum was not treated temporarily,and regular follow-up was performed.All children were followed up for 6 to 36 months,and the end point of observation was unbostructed urination and absence of urethral dilation for 3 months.Conclusion Duckett′s procedure of one-stage urethro plasty for repair and reconstruction of the urethra is effective in the treatment of patients with severe hypospadias,and the clinical complications can be corrected by corresponding methods.Therefore,it is worthy of clinical promotion.