分期Duckett尿道成形术的临床应用  

Clinical application of two-stage Duckett island flap urethroplasty

作　　者：陈嘉波[1] 徐浩伦[1] 杨体泉[1] 罗意革[1] 王红[1] 唐咸明[1] 

机构地区：[1]广西医科大学第一附属医院小儿外科,南宁530021

出　　处：《中华小儿外科杂志》2015年第3期174-177,共4页Chinese Journal of Pediatric Surgery

基　　金：广西自然科学基金（2014GXNSFAA118202）;广西壮族自治区卫生厅计划课题（桂卫Z2013003）

摘　　要：目的 通过总结分期Duckett尿道成形术的临床疗效,分析手术适应证和手术技巧.方法 回顾性分析2012年6月至2014年8月广西医科大学第一附属医院采用分期Duckett手术治疗尿道下裂27例的临床资料.本组年龄2～12岁,中位年龄4岁.一期手术采用Duckett技术,但保留近端吻合口前壁开放,形成近端尿道造瘘.二期手术修复近端尿道造瘘.结果 全组手术成功率为92.6％（25/27）,阴茎外形美观,尿道口正位,排尿通畅.术后发生尿瘘2例,1例为前段尿道小型尿瘘,直径＜0.2 cm,已在2期手术修复近端尿道时予以尿瘘修补痊愈;另1例为近端尿道针尖样尿瘘,随访5个月已自行痊愈.未发现近端吻合口尿瘘或尿道狭窄、尿道憩室.结论 分期Duckett尿道成形术适用于严重阴茎下曲的尿道下裂,尤其是存在背侧包皮或阴茎头发育不良的病例.分期Duckett尿道成形术在降低手术难度的同时也有效降低手术并发症,有利于患儿长期预后.Objective To explore the indications,techniques and efficacies of two-stage Duckett urethroplasty.Methods Retrospective data analyses were conducted for 27 cases of severe curve hypospadias from June 2012 to August 2014.Two-stage Duckett urethroplasty was applied in the first stage.However proximal anastomosis had an open front wall and formed a urethral fistula.And the second-stage surgery was performed 9 months later.Results The overall success rate of operation was 92.6%（25/27）.There were 2 cases of urinary fistula.One cases of small （〈0.2 cm） anterior urinary fistula was repaired by second-stage surgery while another case of proximal urinary fistula became self-cured after 5 months.There was no occurrence of urethral stricture or urethral diverticulum.Conclusions Two-stage Duckett urethroplasty is indicated for severe curve hypospadias,especially dysplasia of penis head and prepuce.And this procedure not only reduces the operative difficulty,but also lowers the incidence of complications.

关 键 词：尿道下裂 泌尿外科手术方法 男性 手术后并发症 

分 类 号：R726.9[医药卫生—儿科]