侧方带蒂包皮筋膜皮瓣在尿道下裂再次手术中的应用

Application of the lateral preputial fascial island flap in hypospadias reoperation

目的:评价侧方带蒂包皮筋膜皮瓣(LPFIF)在尿道下裂再次手术中的应用及效果。方法:回顾性分析南京医科大学附属儿童医院泌尿外科2016年12月至2019年6月行侧方带蒂包皮筋膜皮瓣加盖术治疗尿道下裂再次手术的患儿的临床资料。结果:入组病例共计85例,平均手术年龄4.6岁(1岁6月至12岁8月),LPFIF术式18例,Duplay术式19例,TIP术式25例,Mathieu术式23例。所有病例术后随访均≥6个月。阴茎体及阴茎头外观满意,尿道口位于阴茎头正位,尿道外口呈裂隙状。LPFIF术式术后出现2例尿道瘘,1例阴茎头裂开。Duplay术式术后出现5例尿道瘘。TIP术式术后出现3例尿道瘘,1例尿道狭窄。Mathieu术式术后出现6例尿道瘘,2例阴茎头裂开。所有病例均未出现尿道憩室、皮瓣坏死等并发症。LPFIF术后成功15例(15/18,83.3%)。患儿行自由尿流率检查,行LPFIF术式患儿术后尿流曲线为钟形或高平台形,最大尿流率(8.56±3.99)ml/s,平均尿流率(5.23±2.32)ml/s,与TIP/Duplay术后无显著差异。结论:从目前的术后随访结果来看,TIP和LPFIF在尿道下裂再次手术中的成功率无明显统计学差异,但作为一名合格的小儿泌尿外科医生,必须精通各种尿道下裂再次手术的修复方法,并有能力根据不同患者的条件来调整修复方法。LPFIF尿道成形术可作为尿道下裂再次手术可选择的手术术式之一。

Objective:To evaluate the application and effect of the lateral preputial fascial island flap(LPFIF)in hypospadias reoperation.Methods:We retrospectively analyzed the clinical data on the children patients undergoing hypospadias reoperation with LPFIF in our Department of Urology from December 2016 to June 2019.Results:A total of 85 cases were included in this study,including 18 cases of LPFIF,19 cases of Duplay technique,25 cases of tubularized incised plate urethroplasty(TIP)and 23 cases of Mathieu urethroplasty.The patients were aged from 18 months to 12 years and 8 months,averaging 4.6 years.Postoperatively,all the children were followed up for≥6 months,which found satisfactory appearance of the penis body and glans,the urethral orifice in the normal position of the glans,and the external orifice of the urethra fissured.Urethral fistula occurred in 2 cases and glans dehiscence in 1 after LPFIF;5 of the patients presented urethral fistula after Duplay;3 developed urethral fistula and 1 urethral stricture after TIP;6 showed urethral fistula and 2 glans dehiscence after Mathieu urethroplasty.No postoperative urethral stricture,urethral diverticulum or flap necrosis occurred in any of the cases.Hypospadias reoperation succeeded in 83.3%(15/18)of the cases after LPFIF.The urine flow curve of the LPFIF cases was bell-shaped or high flat-shaped,with a maximum urinary flow rate of 8.56±3.99 ml/s and an average urinary flow rate of 5.23±2.32 ml/s,not significantly different from those of the TIP and Duplay cases.Conclusion:There is no statistically significant difference in the success rate of hypospadias reoperation between TIP and LPFIF.Urethroplasty with LPFIF can be used as one of the surgical options for hypospadias reoperation.