阴茎腹侧翻斗状肉膜瓣覆盖技术在尿道下裂TIP手术中的应用研究  

Covering technique of ventral Dartos flap during tubularized incised plate urethroplasty for hypospadias and observation of curative efficacy

作　　者：曾莉[1] 张志博 顾飞 黄鲁刚[1] 唐小捷 黄一东[1] 马学[1] Zeng Li;Zhang Zhibo;Gu Fei;Huang Lugang;Tang Xiaojie;Huang Yidong;Ma Xue(Department of Pediatric Surgery,West China Hospital,610041,China;West China Healthcare Hospital,Sichuan University,Chengdu Sichuan,610041,China)

机构地区：[1]四川大学华西医院小儿外科,四川省成都市610041 [2]四川大学华西保健医院,四川省成都市610041

出　　处：《临床小儿外科杂志》2021年第11期1031-1037,共7页Journal of Clinical Pediatric Surgery

基　　金：四川省科技厅重点研发项目(编号:2021YFS0244)。

摘　　要：目的探讨阴茎腹侧翻斗状肉膜瓣覆盖技术在阴茎体中远端型尿道下裂TIP手术中的应用效果及可行性。方法分析2018年3月至2020年3月期间于四川大学华西医院由同一经过系统训练的小儿泌尿外科医师采用TIP手术矫治的50例初治阴茎体中远端型尿道下裂患者的临床资料,按照掷硬币法随机分为A、B两组。A组采取TIP手术+阴茎腹侧翻斗状肉膜瓣(腹侧Dartos筋膜)覆盖技术,共26例,平均年龄29.8个月;尿道缺损长度1.0~2.5 cm,平均缺损长度1.74 cm;尿道板宽度8~12 mm,平均9.12 mm;阴茎头宽度12~15 mm,平均13.08 mm。B组采取TIP手术+阴茎腹侧Buck's筋膜瓣反折覆盖技术,共24例,平均年龄29.6个月;尿道缺损长度1.0~2.5 cm,平均缺损长度1.63 cm;尿道板宽度8~12 mm,平均8.92 mm;阴茎头宽度12~15 mm,平均13.00 mm。对比两组患者术后尿瘘发生率,并于术后3个月参照尿道下裂客观评分系统(hypospadias objective scoring evaluation,HOSE)评估和对比两组患者手术效果。结果两组术后均获随访,随访时间6~25个月,A组3例(11.5%)发生尿瘘,B组4例(16.7%)发生尿瘘,差异无统计学意义(χ^(2)=0.273,P=0.601);两组均无尿道狭窄、尿道憩室和阴茎残余下弯(>30°)发生;A、B组术后3个月随访时HOSE评分分别为(14.92±0.8)分和(14.83±1.13)分,差异无统计学意义(t=0.313,P=0.755)。结论阴茎腹侧翻斗状肉膜瓣取材方便,伸展好,厚薄均匀。运用阴茎腹侧翻斗状肉膜瓣覆盖技术的改良TIP手术治疗阴茎体中远端型尿道下裂操作简单可行,疗效确切。Objective To explore the feasibility and efficacy of covering technique of ventral Dartos flap duing tubularized incised plate(TIP)urethroplasty for distal hypospadias and midshaft hypospadias in boys.Methods From March 2018 to March 2020,retrospective analysis was performed for 50 consecutive boys with hypospadias surgically corrected by the same experienced pediatric urologist.They were randomly divided into two groups.Group A:26 boys underwent modified TIP urethroplasty using a covering technique of ventral Dartos flap of penis.The average age was 29.8 months.Urethral defect had an average length of 1.74(1.0-2.5)cm while urethral plate an average width of 9.12 mm.The average width of glans was 13.08(12-15)mm.Group B:24 boys underwent modified TIP urethroplasty using a covering technique of ventral Buck's fascia flap of penis.The average age was 29.6 months.Urethral defect had an average length of 1.63(1.0-2.5)cm while urethral plate an average width of 8.92 mm.The average width of glans was 13.00(12-15)mm.The incidence of urethral fistula was compared after hypospadias repairing.And the efficacies were evaluated by the HOSE scheme at Month 3 post-operation.Results During a follow-up period of(6-25)months,urethral fistula occurred in group A(n=3,11.5%)and group B(n=6,16.7%).No statistically significant difference existed in the incidence of urethral fistula(χ^(2)=0.273,P=0.601).There was no instance of urethral stricture,urethral diverticulum or recurrent ventral curvature(>30°).The HOSE score of group A was 14.92±0.89 and that of group B was(14.83±1.133)at Month 3 post-operation.There was no statistically significant inter-group difference(t=0.313,P=0.755).Conclusion Ventral Dartos flap of penis may be easily harvested with an excellent extension and a uniform thickness.The new technique of covering technique of ventral vertical flip fascia of penis for distal penile hypospadias or midshaft hypospadias is simple,feasible and efficacious during TIP urethroplasty.

关 键 词：阴茎 尿道下裂/外科学 尿瘘 手术后并发症 治疗结果 

分 类 号：R726.9[医药卫生—儿科] R726.1[医药卫生—临床医学]