"逐步法"矫正尿道下裂阴茎下弯策略的观念转变及研究进展  

"Stepwise approach"for treating penile curvature of hypospadias:Conceptual evolutions and challenges

作　　者：李佳义 宋宏程[1] 孙宁[1] 张潍平[1] Li Jiayi;Song Hongcheng;Sun Ning;Zhang Weiping(Department of Urology,Affiliated Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《中华小儿外科杂志》2024年第9期851-856,共6页Chinese Journal of Pediatric Surgery

摘　　要：尿道下裂是小儿泌尿生殖系统常见的先天性畸形,其手术治疗主要包括阴茎下弯矫正、尿道成形以及阴茎外观成形,其中阴茎下弯矫正作为治疗的第一步,对后续尿道成形方式起到了决定性的作用,也成为近10年来国内外学者关注的焦点。阴茎下弯通常是多个致病因素共同作用的结果,在阴茎下弯矫正的过程中,合理、有效地纠正导致阴茎下弯的病因是减少术后复发腹侧弯曲的关键。随着人们对尿道下裂研究的不断深入,"逐步法"矫正阴茎下弯的策略应运而生,为尿道下裂阴茎下弯矫正的规范化治疗建立了良好的开端。近10年里,研究者们发现阴茎长度是影响患儿青春期时满意度的重要因素。人们逐渐摒弃了游离尿道板技术,更多采用横断尿道板的方式纠正尿道板发育挛缩;在纠正阴茎海绵体白膜发育不对称时,人们更倾向于使用腹侧延长术,背侧白膜紧缩技术的使用也相应减少。基于近10年的循证医学证据,研究者在原有基础上对"逐步法"进行了优化与更新。本文就"逐步法"矫正阴茎下弯的观念转变、研究进展及现有争议进行综述,以期加深对尿道下裂阴茎下弯矫正的认知与理解。Hypospadias is a common congenital malformation of pediatric genitourinary system. Conventional surgical approaches include management of ventral curvature, urethroplasty and penile appearance shaping. And management of ventral curvature, as an initial step of treatment, plays a decisive role in the fate of subsequent urethroplasty. It has emerged as a major issue in treating patients with proximal hypospadias over the last decade. Ventral curvature is multifactorial and proper correction of the underlying cause is vital for lowering postoperative curvature recurrence. With continuous researches on hypospadias, "stepwise approach" for managing penile curvature of hypospadias has been proposed, marking a preliminary attempt for standardized treatment of ventral curvature. Over the last decade, researchers have confirmed that penile length was an important factor in child satisfaction at puberty. Urethral plate mobilization has been gradually abandoned in favor of transecting urethral plate for correcting short urethral plate. And ventral lengthening has been recommended for correcting intrinsic corpora disproportion while dorsal shortening lost popularity. Based upon the latest evidence, researchers have updated and simplified the "stepwise approach". This review summarized conceptual changes, research advances and ongoing controversies of "stepwise approach" for penile curvature of hypospadias. The objective was to boost the understanding and proficiency of curvature management.

关 键 词：尿道下裂 阴茎下弯 并发症 

分 类 号：R726.9[医药卫生—儿科]