改良尿道板镶嵌尿道成形术治疗尿道下裂的疗效研究  

Application of modified grafted tubularized incised plate urethroplasty in hypospadias

作　　者：王寿福 胡杨[1] 吴永隆 徐波[1] 陈海琛 WANG Shoufu;HU Yang;WU Yonglong;XU Bo;CHEN Haichen(Department of Pediatric Surgery,Women and Children’s Hospital,School of Medicine,Xiamen University,Xiamen Fujian,361003,P.R.China)

机构地区：[1]厦门大学附属妇女儿童医院(厦门市妇幼保健院)小儿外科,福建厦门361003

出　　处：《中国修复重建外科杂志》2024年第9期1092-1097,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨改良尿道板镶嵌尿道成形术(grafted tubularized incised plate urethroplasty,G-TIP),即阴茎头段G-TIP(glans G-TIP,GG-TIP)治疗尿道下裂的可行性及临床疗效。方法回顾分析2021年1月—2023年6月收治并符合选择标准的137例尿道下裂患儿临床资料。其中,75例采用GG-TIP(GG-TIP组)、62例采用经典G-TIP(G-TIP组)。两组患儿年龄、尿道下裂类型、阴茎长度、阴茎头宽度、阴茎头高度、阴茎下弯角度、口顶距、尿道板宽度,以及阴茎头舟状沟顶点分别至冠状沟背侧中点、腹侧中点的距离及两者差值等基线资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组手术时间、成形尿道长度、口冠距,术后并发症发生情况,术后2周最大尿流率,术后6个月采用国际尿道下裂客观评分标准(HOSE)评价疗效。结果GG-TIP组手术时间较G-TIP组缩短,差异有统计学意义(P<0.05);两组成形尿道长度及口冠距差异均无统计学意义(P>0.05),患儿尿道口均位于阴茎头前端,呈垂直裂隙状。两组患儿均获随访,随访时间6~35个月,中位时间26个月。术后GG-TIP组发生尿道瘘3例、尿道狭窄2例、阴茎头裂开1例,G-TIP组各发生3、3、1例,两组并发症发生率差异均无统计学意义(P>0.05)。GG-TIP组术后2周最大尿流率大于G-TIP组,术后6个月HOSE评分高于G-TIP组,差异均有统计学意义(P<0.05)。结论GG-TIP修复儿童尿道下裂安全、有效,与GTIP相比具有操作相对简便、手术时间缩短、术后尿流率改善明显以及阴茎外观美观的优势。Objective To investigate the clinical feasibility and effectiveness of the modified grafted tubularized incised plate urethroplasty(G-TIP),namely“glans G-TIP(GG-TIP)”,in treatment of hypospadias.Methods A clinical data of 137 children with hypospadias qualified by the selection criteria between January 2021 and June 2023 was retrospectively analyzed.Among them,75 children were treated with GG-TIP(GG-TIP group)and 62 with G-TIP(G-TIP group).There was no significant difference(P>0.05)between the two groups in terms of age,hypospadias type,penile length,penile head width,penile head height,penile curvature,meatus-apex distance,urethral plate width,and distance from the distal endpoint of navicular groove to the dorsal or ventral midline point of the glans corona,and the difference between the two.The operation time,reconstructed urethral length,distance from meatus to ventral glans corona,postoperative complications,maximum urinary flow rate at 2 weeks after operation,and the hypospadias objective scoring evaluation(HOSE)score at 6 months after operation in the two groups were recorded and analyzed.Results The operation time was significantly shorter in GG-TIP group than in G-TIP group(P<0.05);but there was no significant difference(P>0.05)between the two groups in terms of reconstructed urethral length and distance from meatus to ventral glans corona.All urinary meatus located at the tip of glans with vertical fissure shape.All children in the two groups were followed up 6-35 months(median,26 months).During follow-up,there were 3 cases of urethral fistula,2 cases of urethral stricture,and 1 case of glans separation in GG-TIP group,and 3,3,and 1 cases in the G-TIP group,respectively.There was no significant difference in the incidence of complications between the two groups(P>0.05).The maximum urinary flow rate at 2 weeks and the HOSE score at 6 months after operation were significantly higher in GG-TIP group than in G-TIP group(P<0.05).Conclusion GG-TIP is safe and effective for repairing hypospadias in childre

关 键 词：尿道下裂 阴茎头段尿道板镶嵌尿道成形术 儿童 

分 类 号：R726.9[医药卫生—儿科]