横行带蒂岛状包皮内板与横行游离岛状包皮内板Onlay尿道成形术治疗中段型尿道下裂的疗效比较  

Comparison of Onlay transverse island preputial flap and Onlay transverse free island preputial graft for midshaft hypospadias repair

作　　者：毛宇[1] 夏梦[1] 蔡永川 王学军[1] 覃道锐[1] 陈绍基[1] 唐耘熳[1] Mao Yu;Xia Meng;Cai Yongchuan;Wang Xuejun;Qin Daorui;Chen Shaoji;Tang Yunman(Department of Pediatric Surgery of Children’s Medical Center,Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital,Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,China)

机构地区：[1]四川省医学科学院、四川省人民医院、电子科技大学附属医院儿童医学中心小儿外科,成都610072

出　　处：《中华泌尿外科杂志》2019年第6期422-426,共5页Chinese Journal of Urology

基　　金：四川省卫生和计划生育委员会科研基金项目(150206).

摘　　要：目的比较横行带蒂岛状包皮内板Onlay尿道成形术(简称传统Onaly术)与横行游离岛状包皮内板Onaly尿道成形术(简称游离Onaly术)治疗中段型尿道下裂的疗效。方法回顾性分析2013年1月至2018年12月我院收治的59例中段型尿道下裂患者的临床资料,其中49例行传统Onaly术(传统Onaly组),10例行游离Onaly术(游离Onaly组)。传统Onaly组年龄14~81个月,中位年龄28个月;游离Onaly组年龄15~51个月,中位年龄30个月,两组年龄差异无统计学意义(Z=-0.384,P=0.701)。传统Onaly组DonnahooⅡ型阴茎下曲9例,DonnahooⅢ型阴茎下曲40例;游离Onlay组DonnahooⅡ型阴茎下曲3例,DonnahooⅢ型阴茎下曲7例,两组弯曲类型差异无统计学意义(χ^2=0.161,P=0.688)。比较两组患儿尿道下裂分型、成形尿道长度和手术并发症发生率,记录两组患儿术后最大尿流率。结果传统Onaly组尿道下裂分型为阴茎干远段型2例,阴茎干中段型5例,阴茎干近段型42例;术中成形尿道长度中位值2.3 cm(1.3~3.5 cm)。游离Onaly组尿道下裂分型为阴茎干远段型1例,阴茎干中段型2例,阴茎干近段型7例;术中成形尿道长度中位值2.0 cm(1.2~2.5 cm)。两组的尿道下裂分型差异无统计学意义(χ^2=1.313,P=0.519),成形尿道长度差异无统计学意义(Z=-1.732,P=0.083)。术后随访3~72个月,中位时间38个月。传统Onaly组术后出现尿道皮肤瘘11例,阴茎头裂开1例,尿道憩室1例;游离Onaly组术后出现尿道皮肤瘘2例,两组并发症发生率的差异无统计学意义(χ^2=0.001,P=0.973)。患儿家属对术后外形均满意。14例术后3个月完成尿流率检测,其中传统Onlay组12例,尿量为60.2~147.8 ml,平均98.8 ml;最大尿流率为3.5~13.6 ml/s,平均8.1 ml/s。游离Onlay组2例,尿量为101.3~165.4ml,平均133.5 ml;最大尿流率为9.6~15.7 ml/s,平均12.7 ml/s。结论游离Onaly术与传统Onlay术并发症发生率相近,术后能获得较好的最大尿流率和阴茎外形,是治疗中段型尿�Objective To compare the postoperative effects of Onlay transverse island preputial flap and Onlay transverse free island preputial graft for midshaft hypospadias repair.Methods Retrospective analysis of clinical data of 59 patients with midshaft hypospadias who underwent hypospadias repair from January 2013 to December 2018.Among them,49 children were repaired with Onlay transverse island preputial flap,aged from 14 months to 81 months,with the median age of 28 months.Ten children were repaired with Onlay transverse free island preputial graft.The age at surgery was from 15 months to 51 months,with the median age of 30 months.There was no significant difference in term of the age at surgery between the two groups(Z=-0.384,P=0.701).There were 9 cases of DonnahooⅡand 40 cases of DonnahooⅢin the traditional Onaly group,and 3 cases of DonnahooⅡand 7 cases of DonnahooⅢin the free graft Onlay group,respectively.There was no significant difference in the type of chordee between the two groups(χ^2=0.161,P=0.688).The classification of hypospadias,the length of the urethroplasty and surgical complications were compared.The maximum urinary flow rate of some patients was summarized and analyzed after operation.Results Follow-up ranged from 3 to 72 months,with a median period of 38 months.In the children who underwent Onlay transverse island preputial flap,there were 2 cases of distal shaft,5 cases of middle shaft,and 42 cases of proximal shaft.The neourethra was 1.3-3.5 cm,with a median of 2.3 cm.There were 11 cases of fistula,1 case of glan dehiscence,and 1 case of diverticulum.Ten children were treated with Onlay transverse free island preputial graft.There were 1 case of distal shaft,2 cases of middle shaft and 7 cases of proximal shaft.The neourethra was 1.2-2.5 cm,with a median of 2.0 cm.Two cases of fistula occurred after operation.There was no significant difference in hypospadias classification between the two groups(χ^2=1.313,P=0.519).There was no significant difference in the length of the urethra betwee

关 键 词：带蒂包皮内板 游离包皮内板 尿道下裂 

分 类 号：R726.9[医药卫生—儿科]