分期包皮岛状皮瓣尿道板重建术式治疗重度尿道下裂的疗效评价

Staged urethroplasty by tubularization of reconstructed urethral plate using the preputial island flap for severe hypospadias

目的:评价分期包皮岛状皮瓣尿道板重建术式治疗重度尿道下裂的疗效。方法:回顾性分析南京医科大学附属儿童医院泌尿外科2014年5月至2019年2月收治的重度尿道下裂患者91例的临床资料。按手术方法不同分为一期手术组和分期手术组。分析比较两组患者手术年龄、阴茎头直径、矫直后尿道缺损长度及术后尿道瘘、阴茎头裂开、尿道憩室、尿道狭窄发生率及总成功率差异。结果:一期手术患者56例,年龄7个月至12岁,尿道缺损长度3~5 cm,阴茎头直径1.0~1.4 cm;分期手术患者35例,手术年龄7个月至12岁9月,尿道缺损长度3~5 cm,阴茎头直径0.8~2.5 cm。两组患者手术年龄、阴茎直径及尿道缺损长度差异无统计学意义。一期手术组术后18例出现尿瘘,1例出现阴茎裂开,1例出现尿道憩室,1例同时出现尿道憩室及阴茎头裂开,20例经再次尿瘘修补/尿道成形治愈。分期手术组二次尿道成形术后未出现尿瘘,仅4例出现阴茎头裂开,2例经再次手术修复成功,2例患者家长未同意再次手术。一期手术组手术成功率为62.50%,分期手术组手术成功率为88.57%。两组手术成功率比较差异有统计学意义。结论:分期手术可明显降低重度尿道下裂术后尿道瘘的发生率,但可能会增加一部分不需要分期手术患者的手术次数,临床上可根据患者阴茎头发育情况、阴茎下曲程度、尿道缺损长度来综合判断是否需行分期手术。

Objective:To explore the application value of staged urethroplasty by tubularization of the reconstructed urethral plate using the preputial island flap in the treatment of severe hypospadias.Methods:From May 2014 to February 2019,91 children with severe hypospadias received one-or two-stage urethroplasty by tubularization of the reconstructed urethral plate with the preputial island flap.We compared the patients'age,glans diameter,length of the straightened urethral defect,and incidence rates of postoperative urethral fistula,urethral diverticulum,glans dehiscence and urethral stricture between the two groups of patients.Results:The 56 patients in the one-stage group were aged 7-144(21.92±13.37)months old,the urethral defect 3-5(3.565±0.528)cm in length and the glans 1.0-1.4(1.195±0.083)cm in diameter,and the 35 in the two-stage group aged 7-153(24.78±13.59)months,the urethral defect 3-5(3.857±0.696)cm in length and the glans 0.8-2.5(1.206±0.389)cm in diameter.There were no statistically significant differences in age,glans diameter and the length of urethral defect between the two groups.In the one-stage group were found 18 cases of postoperative urinary fistula,1 case of glans dehiscence,1 case of urethral diverticulum,and 1 case of both urethral diverticulum and glans dehiscence,all cured by repeated urinary fistula repair/urethroplasty.No urinary fistula occurred in the two-stage group postoperatively except 4 cases of glans dehiscence,of which 2 were cured by repeated repair and the other 2 refused reoperation.The success rate was significantly higher in the two-stage than in the one-stage urethroplasty group(88.57%vs 62.50%,P<0.05).Conclusion:Two-stage urethroplasty by tubularization of the reconstructed urethral plate with the preputial island flap can significantly reduce the incidence of urethral fistula in patients with severe hypospadias,but may increase the number of operations in those who do not need staged surgery.The necessity of two-stage urethroplasty can be determined according to the development of the glans,the degree of penile curvature,and the length of urethra defect.