改良TIP尿道成形术:恢复尿道解剖结构  

Modified TIP Urethroplasty:Restore the Anatomy of the Penis

作　　者：林俊山[1] 余淑萍 李笃妙[1] 许雅丽[1] LIN Junshan;YU Shuping;LI Dumiao;XU Yali(Department of Pediatric Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China)

机构地区：[1]福建医科大学附属第一医院小儿外科

出　　处：《福建医科大学学报》2019年第6期427-432,共6页Journal of Fujian Medical University

基　　金：福建省自然科学基金资助项目(2016J01537)

摘　　要：目的分析尿道板背侧纵切卷管尿道成形术(TIP)基础上覆盖Buck筋膜联合尿道海绵体(BC)和背侧包皮筋膜组织(P)在无阴茎下弯或轻度阴茎下弯的小儿中远段型尿道下裂的治疗效果。方法回顾性分析104例中远段型尿道下裂患儿的病例资料。其中行BC-P-TIP手术72例(A组);行传统术式TIP+背侧包皮筋膜组织(P-TIP手术)32例(B组)。术后1,3,12月进行门诊随访。术后3月参照尿道下裂客观评分系统(HOSE)对患儿进行手术效果评估,对两组病例的一般资料、HOSE评分、并发症情况进行统计学分析。结果A,B组术后3月HOSE评分平均分分别为15.42及13.90,差别有统计学意义(P<0.01)。A,B组的尿瘘发生率为8.3%及25%,差别有统计学意义(P<0.05)。A,B组的尿道狭窄发生率为4.2%及0%,差别无统计学意义(P>0.05)。结论BC-P-TIP改良术式相对于P-TIP术式能有效减少尿瘘发生,术后外观满意、排尿功能良好,手术操作简单易学,取材方便,解剖损伤小,且接近正常尿道的解剖结构,值得进一步探讨及推广。Objective To retrospectively analyze the effect of the tubularized incised plate urethroplasty(TIP)covered with Buck′s fascia and corpora spongiosum(BC)and the dorsal prepuce fascia tissue(P)in middle and distal hypospadias without penile curvature or mild penile curvature in children.Methods This study retrospectively analyzed the data of 104 children with middle or distal hypospadias who underwent primary surgery from January 2013 to August 2018.Among them,72 patients in group A underwent BC-P-TIP surgery,32 patients in group B underwent TIP covered with dorsal foreskin fascia(P-TIP surgery).Outpatient follow-up was performed 1 month,3 months,and 12 months after surgery.The HOSE(the Hypospadias Objective Scoring System,HOSE)scoring criteria were used to evaluate the surgical results in 3 months after surgery.General data,HOSE scores,and complications in the two groups were analyzed.Results The postoperative results were scored according to the position and the shape of the urethral orifice,the flow of urine,the straightness of the penis after erection,the presence or absence of urinary fistula and its complexity.In 72 cases of BC-P-TIP surgery group,among them 6 cases(8.3%)showed urinary fistula;3 cases(4.2%)had urethral stricture;2 cases(2.8%)had incision infection with urinary fistula.There were 32 patients in the P-TIP operation group,among them 8 patients(25%)showed urinary fistula;2 patients(6.3%)with incision infection;no urethral stricture.The incidence of urinary fistula in the two groups was compared by chi-square test,P<0.05(continuous correction chi-square value 3.949,P=0.047),the difference was statistically significant.Conclusion The BC-P-TIP procedure can effectively reduce the occurrence of urinary fistula compared with the P-TIP procedure and has good urination function.The tissue is easy to harvest and has less anatomical damage than P-TIP.It is close to the anatomy of normal penis and postoperative appearance is satisfied.The surgical operation is easy to learn and worth further exploration

关 键 词：尿道下裂 筋膜 尿瘘 尿道/外科学 

分 类 号：R695[医药卫生—泌尿科学] R726.95[医药卫生—外科学]