尿道口前移-阴茎头成形术在尿道下裂再手术患者中的应用

Application of meatal advancement glanduloplasty incorporation in reoperative hypospadias repair

目的观察尿道口前移-阴茎头成形术(MAGPI)在尿道下裂再手术中的应用效果。方法回顾性分析2010年9月至2020年7月于四川省人民医院小儿外科行尿道下裂再手术修复中应用MAGPI手术的31例患者资料,阴茎头区域修复采用MAGPI手术,术中再根据其合并的并发症情况选择相应的尿道下裂修复术式进行手术修复。术后随访并记录并发症发生情况、尿道下裂阴茎外观客观评分(HOSE)和自由尿流率。结果本组患者共31例,随访时间7个月~11.5年,中位随访时间6.2年。年龄在2岁6个月~24岁2个月,中位年龄5.3岁。HOSE评分(满分16分计)术前7~16分,平均(11.6±2.3)分;术后12~16分,平均(15.5±0.9)分。改良HOSE评分(满分20分计)术前11~19分,平均(15.4±2.2)分;术后16~20分,平均(19.4±0.9)分。HOSE及改良HOSE评分术前与术后差异均具有统计学意义(P=0.000)。19例获得术后3个月以上尿流率检查,最大尿流率(Qmax)8.7~29.5 mL/s,平均(14.3±5.4)mL/s。结论MAGPI术式应用于尿道下裂再手术阴茎头区的修复可获得较好的尿流率及阴茎外观的改善,术后相关并发症率不高,手术安全有效。

Objective To investigate the application of meatal advancement glanduloplasty incorporation(MAGPI)in reoperative hypospadias repair.Methods A retrospective analysis was performed based on the clinical data of 31 reoperative hypospadias patients recruited during Sep.2010 and Jul.2020,who underwent MAGPI to reconstruct the glans,and other procedures were adopted to repair complications.During the follow-up,the complications,score of hypospadias objective scoring eva-luation(HOSE)and urinary flow rate were recorded.Results The median follow-up was 6.2 years(ranged from 7 months to 11.5 years),and the median age was 5.3 years(ranged from 2 years and 6 months to 24 years and 2 months).The pre-and post-operative HOSE score were 7-16(11.6±2.3)vs.12-16(15.5±0.9),P=0.000.The modified pre-and post-operative HOSE score were 11-19(15.4±2.2)vs.16-20(19.4±0.9),P=0.000.There were significant differences between the data.The urinary flow rate was collected from 19 cases,and the maximal urinary flow rate(Qmax)was 8.9-29.5 mL/s[average(14.3±5.4)mL/s].Conclusion MAGPI can significantly improve urinary flow rate and cosmetics of glans.It causes few complications and is safe and effective for reconstruction of glans in reoperative hypospadias patients.