摘要
目的评价加盖包皮岛状皮瓣法(Onlay island flap法)与管形包皮岛状皮瓣法(Tubularized island flap法)手术治疗尿道下裂的适应证及疗效.方法总结分析166例尿道下裂修复手术及术后并发症.患儿年龄1～15岁,平均5.1岁.冠状沟型及阴茎体前型尿道下裂36例,阴茎体型81例,阴茎根型36例,阴囊及会阴型13例,其中外院行阴茎下弯矫正术后11例.合并阴茎下弯139例,轻度43例,中度43例,重度53例.采用加盖包皮岛状皮瓣法79例,管形包皮岛状皮瓣法87例.结果 166例手术成功率为90.4%.166例随访2年均未发生尿道狭窄、尿道憩室、阴茎皮肤坏死等合并症.加盖包皮岛状皮瓣法术后发生尿瘘4例(5.1%),阴茎下弯复发7例(8.9%),手术成功率为86.1%.管形包皮岛状皮瓣法术后发生尿瘘4例(4.6%),阴茎下弯复发1例(1.1%),手术成功率为94.2%.2种术式尿瘘发生率比较,差异无统计学意义;而阴茎下弯复发率比较,差异有统计学意义.结论加盖包皮岛状皮瓣法适用于尿道板发育好的阴茎体及阴茎根型病例,管形包皮岛状皮瓣适用于尿道口位于冠状沟至会阴合并重度阴茎下弯的各型尿道下裂.
Objective To evaluate the indications and efficacy of onlay preputial island flap and tubularized preputial island flap for the repair of hypospadias. Methods A total of 166 children （mean age ,5.06 years; age range, 1 - 15 years） with hypospadias underwent hypospadias repair by onlay （ n = 79） or tubularized preputial island flap （ n = 87） technique. Of them ,36 cases had hypospadias of coronary sulcus and anterior penis body type;81 ,penis body type;36 penis root type;13, scrotal and perineal type. Of the 166 cases, 139 had concomitant curved lower penis, including 43 cases of mild ,43 of intermediate and 53 of severe degree. The surgical results and postoperative complications were retrospectively analyzed. Results The overall operative success rate was 90.4%. During a mean follow-up of 2 years, no urethral stricture, diverticula and cutaneous necrosis of the penis occurred. In those who underwent onlay repair,4 patients （5.1% ） developed urethral fistula, and 7 （8.9%） developed recurrent curvature of lower penis. The operative success rate was 86.1%. In those who underwent tubularized preputial island repair,4 patients （4.6%） developed urethral fistula, and only 1 （ 1.1% ） had curvature of lower penis. The operative success rate was 94.2%. There was no significant difference in the rates of urethral fistula between the 2 groups （ P 〉 0.05 ） ; whereas the difference in the recurrence rates of curvature of lower penis between the 2 groups was significant （P 〈 0.05）. Conclusions The onlay preputial island flap urethroplasty,a variant of the tubularized preputial island flap,is suitable for the cases of distal hypospadias who have the well-developed urethral plate and exhibit little or no chordee following skin tethering release and tunica albuginea placation. Tubularized preputial island flap technique is suitable for various hypospadias,especially for those with severe chordee in which transverse section of the urethral plate is needed.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第12期847-849,共3页
Chinese Journal of Urology
关键词
尿道下裂
尿道板
手术
Hypospadias
Urethral plate
Surgery
