Duckett和Byars两种分期模式在阴茎头发育不良的重型尿道下裂中的应用  

Staged Duckett urethroplasty and Byars reconstruction for severe hypospadias with dysplastic glans

作　　者：蒋加斌 潮敏 张殷 张晔 张开平 郝宗耀[1] JIANG Jia-bin;CHAO Min;ZHANG Yin;ZHANG Ye;ZHANG Kai-ping;HAO Zong-yao(Department of Urology/Anhui Medical University Research Institute of Urology,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China;Department of Urology,Anhui Provincial Children’s Hospital,Hefei,Anhui 230051,China)

机构地区：[1]安徽医科大学第一附属医院泌尿外科/安徽医科大学泌尿外科研究所,安徽合肥230022 [2]安徽省儿童医院泌尿外科,安徽合肥230051

出　　处：《中华男科学杂志》2022年第2期135-139,共5页National Journal of Andrology

摘　　要：目的:探讨利用包皮内板部分尿道成形和尿道板重建两种分期手术模式治疗合并阴茎头发育不良的儿童重型尿道下裂的临床疗效。方法:回顾性分析2015年9月至2020年5月安徽医科大学第一附属医院泌尿外科收治的57例合并阴茎头发育不良的儿童重型尿道下裂的临床资料,初治年龄5个月至3岁11个月,平均年龄1岁9个月,初治时阴茎头直径均<1.4 cm,均为阴囊型或会阴型,两次手术间隔6个月至41个月,平均间隔14个月。根据分期手术模式分为两组,A组25例,采用Duckett术式一期远端尿道成形,二期近端尿道成形;B组32例,一期利用包皮内板重建尿道板,二期采用Duplay尿道成形术。观察两组疗效。结果:术后随访12~56个月,平均35个月。两组患者两次手术完成后,A组出现4例尿瘘、1例阴茎头部尿道裂开、1例尿道憩室、1例尿道狭窄,无阴茎复弯,发生并发症病例数6例,总并发症发生率24%(6/25);B组出现9例尿瘘、9例阴茎头部尿道裂开、2例尿道憩室、无尿道狭窄,无阴茎复弯,发生并发症病例数14例,总并发症发生率43.8%(14/32)。比较两组总并发症及每组尿瘘、阴茎头部尿道裂开、尿道憩室、尿道狭窄发生情况,A组阴茎头部尿道裂开发生率明显低于B组,差异有统计学意义(P=0.043),其余观察指标差异均无统计学意义(P>0.05)。结论:对于合并阴茎头发育不良的儿童重型尿道下裂采用Duckett和Byars两种分期手术模式均可取得较理想的治疗效果,但是Byars分期模式更易出现阴茎头裂开,后续修复的难度较大。Objective:To study the effects of staged Duckett urethroplasty and Byars reconstruction in the treatment of severe hypospadias with dysplastic glans.Methods:We retrospectively analyzed the clinical data on 57 cases of severe hypospadias with dysplastic glans treated by two-stage Duckett urethroplasty or Byars reconstruction from September 2015 to May 2020.At stage-Ⅰtreatment,the patients were aged from 5 to 47(mean 21)months,the diameter of the glans less than 1.4 cm,and the interval between the two stages from 6 to 41(mean 14)months.The patients underwent Duckett urethroplasty,distal in stageⅠand proximal in stageⅡ(group A,n=25)or Byars reconstruction with the urethral plate in stageⅠand Duplay urethroplasty in stageⅡ(group B,n=32).Postoperative follow-up lasted 12-56(mean 35)months.Results:After stageⅡsurgery,penile straightening and smooth appearance of the graft were achieved in all the patients.Six cases of postoperative complications(24%)were observed in group A,including 4 cases of urinary fistula,1 case of glans dehiscence,1 case of urethral diverticulum and 1 case of urethral stricture,while 14 cases(43.8%)were observed in group B,including 9 cases of urinary fistula,9 cases of glans dehiscence and 2 cases of urethral diverticulum,with a remarkably lower incidence rate of glans dehiscence in group A than in B(P=0.043),but no statistically significant difference in the other observations between the two groups(P>0.05).Conclusion:Both staged strategies of Duckett urethroplasty and Byars reconstruction can be used for the treatment of severe hypospadias with dysplastic glans,but the latter may result in a higher incidence rate of glans dehiscence postoperatively and bring more difficulties to subsequent repair.

关 键 词：尿道下裂 重型 阴茎头发育不良 分期手术 

分 类 号：R699.6[医药卫生—泌尿科学] R699.8[医药卫生—外科学]