经阴茎头隧道和纵切阴茎头成形尿道口在Duckett术式中的疗效及对比观察  

Clinical curative effect and comparative observation in the Duckett operation between glans tunnel and longitu- dinal cutting glans to form urethral opening

作　　者：李刚[1] 李爽[1] 王军[1] 廖嫚 李巍[3] 杨春雷[1] 雷伟[1] 郭晖[1] 马慧[1] 程银涛[1] 郭祥[1] 

机构地区：[1]武汉市儿童医院泌尿外科,430014 [2]武汉市妇幼保健院儿童保健科 [3]徐州医学院临床医学系学生

出　　处：《中华实用儿科临床杂志》2014年第11期814-817,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨经阴茎头隧道和纵切阴茎头成形尿道口在Duckett术式中的临床疗效及对比观察。方法回顾2011年至2013年武汉市儿童医院收治的86例后型尿道下裂初次手术患儿，均采用Duckett术式成形尿道，尿道口成形分别采用经阴茎头隧道和纵切阴茎头成形尿道口，根据患儿术后远端尿道狭窄、尿道瘘、尿道憩室、阴茎头伤口裂开及伤口恢复情况进行比较分析，了解其术后效果差异。结果86例随访6—12个月，阴茎伸直满意，无下弯残留，无阴茎头坏死。49例阴茎头大、呈圆柱状且舟状窝不明显患儿中26例采用纵切法成形尿道口，发生尿道瘘3例；尿道狭窄3例，其中远端尿道狭窄2例；尿道憩室1例；阴茎头伤口裂开2例；23例采用隧道法发生尿道瘘及尿道狭窄各1例，均发生于阴茎腹侧冠状沟近端。37例阴茎头小、扁平且舟状窝较深患儿，其中21例采用隧道法发生尿道瘘3例，5例尿道狭窄均发生于尿道远端，尿道憩室2例，远端尿道裂开1例；16例采用纵切法阴茎冠状沟处发生尿道瘘2例，远端尿道狭窄1例。阴茎头形状、大小及冠状沟深浅相同的患儿分别采用阴茎头纵行切开法与阴茎头隧道法成形尿道口预后比较差异有统计学意义（P〈0．05）；阴茎头形状、大小及冠状沟深浅不同的患儿采用同一方法（纵切法或隧道法）预后比较差异有统计学意义（P〈0．05）。结论阴茎头呈圆柱状且舟状窝不明显、阴茎头较大的患儿适合采用隧道法；阴茎头相对扁平且舟状窝较深、阴茎头较小的患儿宜采用阴茎头纵切法。Objective To explore clinical curative effect and compare observations of the Duckett operation between glans tunnel and longitudinal cutting glans to form urethral opening. Methods Retrospective study from 2011 to 2013 in Wuhan Children＇s Hospital, of 86 cases of hypospadias in children undergoing surgery to form urethra, with surgical procedures adopting Duckett surgical method to form the urethra. Urethroplasty was performed through glans tunnel or longitudinal incision to form urethral opening, and postoperation results were compared according to the condi- tions of the children with distal urethral stricture, urethral fistula, urethral diverticulum, glans wound dehiscence and wound recovery. Results Eighty-six cases were followed up for 6 to 12 months, with satisfaction of the straight penis, without reeurved residue, or glans necrosis. Among the 49 cases of big glans in cylindrical shape without obvious scap- hold fossa, 26 cases of children underwent longitudinal incision to form urethra, in which urethral fistula occurred in 3 cases. There were 3 cases of urethral stricture, including 2 cases of distal urethral stricture. There were 1 case of ure- thral diverticulum and 2 cases of glans wound dehiscence. Twenty-three cases adopted the tunnel method with the occurrence of urethral fistula in 1 case and urethral stricture in another, which both occurred at the ventral penile coronal proximal end. Among the 37 cases with small glans in fiat shape and deep scaphoid fossa, 21 cases adopted the tunnel method with the occurrence of urethral fistula in 3 cases. Five cases of urethral stricture occurred at the distal urethra, 2 cases of urethral diverticulum, and 1 case of distal urethral split. Sixteen cases underwent vertical cutting method with the occurrence of urethral fistula at penis coronal sulcus in 2 cases, 1 case of distal urethral stricture. Children who had similarity in penis head shape, size and coronal sulcus depth adopted separately longitudinal incision or tunnel method to form urethra and prog

关 键 词：尿道口成形 阴茎头隧道 纵切阴茎头 尿道下裂 

分 类 号：R726.9[医药卫生—儿科]