切断尿道板加盖岛状皮瓣法一期治疗重度尿道下裂疗效观察

Clinical observation of one-stage treatment of severe hypospadias with incision of urethral plate and island flap

目的:观察切断尿道板加盖岛状皮瓣法(Onlay island flap)一期治疗重度尿道下裂手术的临床疗效及并发症情况。方法:开封市儿童医院2019年3月—2023年3月对21例重度尿道下裂患儿采用一种切断尿道板Onlay技术进行了手术。手术方式:切断尿道板后,伸直阴茎体,将分离出来的尿道板再缝合于阴茎海绵体白膜上,游离背侧带血管蒂的岛状皮瓣,将岛状皮瓣加盖缝合于尿道板,尿道板缺损处将岛状皮瓣缝合在尿道板延长平行线的海绵体白膜上;尿道板缺损处缝合剪下的膜状尿道板促进海绵体上皮化。进行6个月以上的长期随访,观察尿瘘,尿道狭窄及其他并发症发生情况。结果:21例尿道下裂外观好,无阴茎下弯,2例尿瘘,给予尿瘘修补术治愈,无尿道憩室,排尿通畅,无尿道狭窄或排尿困难。结论:切断尿道板Onlay术一期治疗合并阴茎下弯的重度尿道下裂,手术方法简单,术后效果满意,值得研究和推广。

Objective To observe the clinical effect and complications of one-stage resection of urethral plate with island flap(Onlay)in the treatment of severe hypospadias.Methods From March 2019 to March 2023,21 patients with severe hypospadias were operated by Onlay technique,which cut off the urethral plate.After the urethral plate was cut,the penis body was extended.The separated urethral plate was stitched on the white membrane of the penile cavernosa.The free dorsal island flap with vascular pedicle was covered and stitched on the urethral plate,and the defect of the urethral plate was stitched on the white membrane of the urethral plate extending parallel lines.The membrane urethral plate clipped by suture at the defect of urethral plate promotes the epithelialization of the cavernous body.Long-term follow-up was conducted for more than 6 months to observe the incidence of urinary fistula,urethral stricture and other complications.Results These 21 cases of hypospadias had good appearance without chordee of penis.Two case of urinary fistula were cured by fistula repair.No urethral diverticulum,obstructed urination,urethral stricture or dysuria was found.Conclusion One-stage Onlay resection of urethral plate in the treatment of severe hypospadias complicated with chordee of penis is simple and satisfactory.It is worth studying and popularizing.