阴茎背侧皮肤紧缩技术治疗儿童尿道下裂轻度阴茎下弯的效果  

Study on the effect of dorsal skin-tightening technique on the correction of mild penile curvature in children with hypospadias

作　　者：沈一丁[1] 孙珑 诸林峰 赵冬艳 杨帆 陈光杰[1] 黄勇[1] 唐达星[1] Shen Yiding;Sun Long;Zhu Linfeng;Zhao Dongyan;Yang Fan;Chen Guangjie;Huang Yong;Tang Daxing(Department of Urology,Children’s Hospital,Zhejiang University School of Medicine,National Clinical Research Center For Child Health,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属儿童医院泌尿外科,国家儿童健康与疾病临床医学研究中心,杭州310000

出　　处：《中华泌尿外科杂志》2021年第12期915-918,共4页Chinese Journal of Urology

摘　　要：目的探讨阴茎背侧皮肤紧缩技术治疗儿童尿道下裂轻度阴茎下弯的效果。方法回顾性分析2017年1月至2020年9月浙江大学医学院附属儿童医院收治的95例尿道下裂伴轻度阴茎下弯患儿的临床资料。95例行阴茎皮肤肉膜脱套后均存在阴茎下弯且<30°。根据手术方法将患者分为2组。背侧皮肤紧缩组43例,中位年龄1.1(0.4~1.5)岁;术中脱套后尿道开口于阴茎远端36例、近端7例;予背侧皮肤紧缩技术纠正下弯,即脱套后于阴茎背侧根部12点处成形阴茎耻骨角,并于12点处缝合包皮与环切后保留的黏膜领,保持一定张力。背侧中线白膜折叠组52例,中位年龄1.5(0.5~2.6)岁;脱套后尿道开口于阴茎远端41例,近端11例;予背侧中线白膜折叠技术纠正下弯,即脱套后于背侧中线切开Buck筋膜并分离至白膜,行1针或上下两针纵行缝合折叠白膜。两组术中均行人工勃起试验证实阴茎下弯被矫正。术后6、12个月复查,之后每年随访,评估术后并发症发生情况和阴茎下弯情况。结果术后平均随访1.6(0.6~3.0)年,所有患儿根据正侧面照片测量显示均无阴茎下弯。术后7例发生尿道皮肤瘘,其中背侧皮肤紧缩组3例,背侧中线白膜折叠组4例,两组差异无统计学意义(P>0.05)。95例均未发生尿道狭窄和憩室,无阴茎隐匿。结论阴茎背侧皮肤紧缩技术可有效纠正尿道下裂轻度阴茎下弯,术后短期效果佳。Objective To investigate the therapeutic effect of dorsal skin-tightening technique on the correction of mild penile curvature in children with hypospadias.Methods The clinical characteristics of hypospadias patients(95 cases)with mild penile curvature(<30°)after degloving penis during operation in our hospital from Jan 2017 to Sep 2020 were analyzed retrospectively.Group A:A new technique,reconstructing penile pubic angle at 12 o'clock position of penile dorsal side after degloving and suturing forskin outer and inner plate with tension at 12 o'clock position,was performed in dorsal skin-tightening group(43 cases).Gtoup B:while in dorsal midline tunica albuginea plication group(52 cases),Buck fascia was incised on dorsal midline area,following by tunica albuginea plication with one or two stitches.The patients in Group A were 0.4 to 1.5 years old,and the median age was 1.1 years,urethral orifice were located on distal shaft in 36 cases,proximal in 7 cases.The patients in Group B were 0.5 to 2.6 years old,and the median age was 1.5 years,urethral orifice were located on distal shaft in 41 cases,proximal in 11 cases.The penile ventral curvature degree was recorded during regular follow-up(postoperative 6 and 12 months),as well as postoperative complications.Results Artificial erection test showed penile curvature was corrected during surgery by measuring with protractor.There was no chordee by measuring with the side photos in all patients during an average of 1.6 years follow-ups.There were 4 case of urethral fistula in Group B and 3 cases in Group A.No cases of urethrostenosis,diverticulum or concealed penis was recorded.The difference of postoperative complications had no statistical significance.Conclusion Hypospadias with mild penile curvature could be effectively corrected by dorsal skin-tightening technique,which showed a good result of early follow-up.

关 键 词：尿道下裂 阴茎下弯 手术 

分 类 号：R726.9[医药卫生—儿科]