保留尿道板加包皮岛状皮瓣尿道成形术一期治疗尿道下裂的疗效观察  

One-stage repair with foreskin pedicle island flap plus preserving urethral plate urethroplasty for hypospadias

作　　者：刘伟[1] 吴荣德[1] 张北叶 

机构地区：[1]山东大学附属省立医院小儿外科,济南250021 [2]台湾林口长庚医院小儿外科

出　　处：《中华小儿外科杂志》2015年第3期170-173,共4页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金（81400575）;山东省自然科学基金（ER2012HQ012）

摘　　要：目的 随访保留尿道板加包皮岛状皮瓣尿道成形术一期治疗尿道下裂的效果,探讨该方法的优缺点及可行性.方法 回顾性分析2007年6月至2013年1月采用全剥离并保留尿道板加包皮岛状皮瓣尿道成形术一期修复尿道下裂患儿80例的临床资料.其中,阴茎阴囊型53例,阴囊型21例,会阴型6例；年龄1～9岁,平均2.5岁.术后随访0.5～6年,关注患儿术后外观及排尿功能.结果 本组80例患儿均一期完成手术,重建尿道长度2.5～5.0 cm,平均3.8 cm.所有病例外观满意,阴茎伸直满意,尿道外口位于阴茎头正常位置,阴茎阴囊外观良好.一次手术成功62例,成功率为77.5％,术后排尿通畅、尿线粗,无尿瘘;术后6个月尿流率检测结果显示最大尿流率为（7.9±0.4）ml/s,平均尿流率为（5.2±0.3）ml/s.并发症发生率为22.5％（18/80）.其中,尿道瘘12例,已行尿道瘘修补术治愈；尿道狭窄2例,均为尿道外口狭窄,行尿道扩张治疗后好转；4例术后形成尿道憩室,再次手术治愈.结论 该手术方法在新成形的尿道中最大限度的保存了尿道板的成分,作为修复尿道的材料有力地支持了新尿道的愈合,避免了吻合口的环形吻合,明显减少了尿道狭窄并发症的发生；同时将尿道板完全剥离,可切除尿道板深部与白膜之间的纤维组织,使阴茎充分矫直,保证了术后阴茎外观的满意.该术式在一期修复尿道下裂中效果满意,疗效可靠,有较好的临床应用价值.Objective To explore the indications,techniques and complications of foreskin pedicle island flap plus stripping and preserving urethral plate urethroplasty in the treatment of hypospadias.Methods Retrospective reviews were conducted for 80 patients undergoing proximal hypospadias repair with tubularized transverse preputial island flap urethroplasty （Duckett） plus stripping and preserving urethral plate urethroplasty （Onlay） between Jun.2007 and Jan.2013.The age range was 1-9 years.The types were proximal shaft （n =53）,scrotal （n =21） and perineal （n=6）.And cosmetic and functional assessments were made during a follow-up period of 6-72 months.Results The mean length of neourethra was 3.8 （2.5-5.0） cm.The straightening and appearance of penis were satisfactory and meatus was located postoperatively at normal anatomical position.Sixty-two patients （77.5%） had better curative efficacy without complications.The maximum flow rate （Qmax） was （7.9 ± 0.4） ml/s and the average flow rate （Qave） （5.2 ± 0.3） ml/s.Fistula of 12 cases was repaired.Stricture of urethral external orifice was relieved after urethral dilation in 2 cases.And 4 patients of diverticular distension were reoperated.Conclusions Fully stripping and preserving urethral plate decrease the occurrence of complications,especially stricture and permitting penile straightening.This procedure restores good function and normal appearance of penis and it may be used for urethroplasty of proximal hypospadias with a wide and healthy urethral plate.

关 键 词：尿道下裂 外科皮瓣 泌尿外科手术方法 男性 

分 类 号：R726.9[医药卫生—儿科]