尿道板重建分期尿道成形术和Duckett造瘘分期尿道成形术治疗重型尿道下裂的对比研究  

Comparative study of urethral plate reconstruction stage urethroplasty and Duckett fistulization stage urethroplasty for treating severe hypospadia

作　　者：毛宇[1] 王茹[2] 夏梦[1] 陈绍基[1] 唐耘熳[1] MAO Yu;WANG Ru;XIA Meng;CHEN Shaoji;TANG Yunman(Department of Pediatric Surgery,Children Medical Center,Sichuan Provincial People ′ s Hospital,Chengdu,Sichuan 610072,China;West China Hospital of Sichuan University,Chengdu,Sichuan 610072,China)

机构地区：[1]四川省人民医院儿童医学中心小儿外科,成都610072 [2]四川大学华西医院,四川成都610041

出　　处：《现代医药卫生》2018年第6期801-804,共4页Journal of Modern Medicine & Health

基　　金：国家自然科学基金青年基金资助项目(81501673);四川省人民医院青年基金资助项目(30305030609)

摘　　要：目的分析Duckett造瘘分期尿道成形术和尿道板重建分期尿道成形术治疗重型尿道下裂患儿的疗效,探讨2种手术方式的适应证。方法回顾性分析2013年8月至2016年12月四川省人民医院儿童医学中心小儿外科完成分期手术矫治的68例重型尿道下裂患儿的临床资料。患儿第1次手术时年龄1岁3个月至8岁3个月,平均3.17岁。采用尿道板重建分期尿道成形术进行尿道下裂修复的患儿23例(A组),其中阴囊型尿道下裂9例,会阴型尿道下裂14例;采用Duckett造瘘分期尿道成形术进行尿道下裂修复的患儿45例(B组),其中阴囊型尿道下裂16例,会阴型尿道下裂29例。对比分析2组2种手术方式治疗重型尿道下裂患儿的临床疗效。结果术后随访12~52个月,平均27个月。A组患者在二期手术完成后出现尿瘘2例,尿道狭窄1例,尿道裂开1例,并发症发生率为17.4%。B组患儿在二期手术完成后出现尿瘘3例,2例出现尿道憩室,并发症发生率为11.1%。2组手术并发症发生率比较,差异无统计学意义(P=0.73)。结论尿道板重建分期尿道成形术和Duckett造瘘分期尿道成形术均适应用于重型尿道下裂的修复治疗。Objective Analyzed and compared the outcome in two different severe hypospadias repair techniques,that were plate reconstruction and staged tubularization urethroplasty and Duckett urethroplasty with proximal urethrostomy.Discussed the indication of the two techniques.Methods Retrospectively analyzed the clinical data of68severe hypospadias patients who completed the staged repair in our hospital from August2013to December2016.The patients were aged from1year and3months to8years and3months,with the average of3years and2months,when they underwent the first stage repair.In group A,23cases were applied for plate reconstruction and staged tubularization urethroplasty.9cases were scrotal hypospadias,while14cases were perineal hypospdias.In group B,45cases were applied for Duckett urethroplasty with proximal urethrostomy.16cases were scrotal hypospadias,while29cases were perineal hypospadias.Results Patients were followed up for12to52months,with an average of27months.The complication rate in group A was17.4%,with2cases fistula,1stenosis and1dehiscence.The complication rate in group B was11.1%,with3cases fistula,2cases diverticulum.There was no statistical difference in the complication rate between the two groups(P=0.73).Conclusion Both late reconstruction and staged tubularization urethroplasty and Duckett urethroplasty with proximal urethrostomy are available for severe hypospadias repair.

关 键 词：尿道下裂 分期手术 尿道成形术 尿道板重建 

分 类 号：R726.9[医药卫生—儿科]