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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:

06

期数:

2006年12期

页码:

965-967

栏目:

出版日期:

2006-12-30

文章信息/Info

Title:

Microsurgery for the repair of pediatric hypospadias

作者:

段光琦; 潘永康; 张敏; 浦征宇

江苏省南通瑞慈儿童医院外科,南通,226010

Author(s):

Duan Guangqi;  Pan Yongkang;  Zhang Min;  et al.

Department of Surgery,Nantong Rich Children’s hospital, Nantong 226010, China

关键词:

显微外科; 手术; 尿道下裂

Keywords:

Microsurgery; 　Operation; 　Hypospadias

分类号:

R726.9;R695

文献标志码:

A

摘要:

目的 探讨提高尿道下裂治愈率的有效措施.方法 利用显微外科技术对本组64例尿道下裂患儿进行一期尿道修复.年龄7个月～14岁,平均5.6岁.阴茎头及冠状沟型16例,阴茎体型36例,阴囊会阴型12例.伴阴茎阴囊转位3例,隐睾4例6侧,鞘膜积液2例,斜疝2例.先期外院矫正下弯但未成形尿道1例,Duckett手术失败2例.据病情不同,分别选用不同的手术方法:阴茎头型用尿道口前移、阴茎头成形法(MAGPI术式);冠状沟型或距冠状沟较近的阴茎体型用尿道口基底血管皮瓣法(Mathieu术式);尿道口在阴茎体2/3以外段伴有阴茎轻度下弯或无下弯者用尿道板纵切卷管法或加盖岛状皮板法(Snodgrass术式或Onlay术式);有严重阴茎下弯的所有阴茎体型选横裁或纵裁包皮岛状皮瓣尿道成形(Duckett术式或Hodgson术式);阴囊型或会阴型用阴囊中缝皮管加横裁包皮岛状皮瓣成形尿道(Duplay联合Duckett术式).对20例再次手术者或包皮材料不理想、重度尿道下裂者手术结束前行膀胱穿刺造瘘.结果 手术治愈57例,治愈率89.1%(57/64).手术时间90～180 min,平均120 min.术中出血量＜15 ml.并发尿道瘘3例,尿道狭窄4例,无尿道憩室发生.54例获得随访2～36个月,平均19个月,均符合尿道下裂治愈标准.结论 应用显微外科技术,合理选用手术方法,重视术中技巧,能明显提高手术成功率,而且手术年龄可提早到婴幼儿.

Abstract:

Objective　To study effective methods for improving the cure rate of hypospadias.　M ethods　Microsurgical techniqueswere employed for the primary repair of different types of hypospadias in 64 pediatric cases. The patients were aged 7 months ~ 14 years (mean, 5. 6 years). The location of the openingwas at the glans and the coronalditch in 16 cases, at the body of the penis in 36 cases, and at the scrotum and perineum in 12 cases. Accompanyingmalformations ormorbidities included 3 cases of translocation of penis and scrotum, 4 cases of cryptorchidism, 2 cases ofhydrocele, and 2 cases of indirecthernia. Therewere 1 case of previous chordee correction without urethroplasty and 2 cases of failure from a Duckett procedure. Different techniques were employed for different types ofhypospadias: themeatoplasty and glanuloplasty (MAGPI) for subcoronalhypospadias, theMathieu flip- flap procedure for proximal hypospadias, the Snodgrass repair or the Onlay island flap repair for distal hypospadias, the Duckett procedure or the Hodgson procedure for severe hypospadias with chordee, and the Duplay procedure combined with the Duckett procedure for anterior hypospadias. A cystostomy was required in 20 cases due to re-operation, unsatisfactory foreskin, or severe hypospadias.　Results　Fifty-seven caseswere cured (89. 1%, 57/64). The operation time was 90~180 min (mean, 120 min). The intraoperative blood losswas less than 15 m.l Surgical complications included 3 cases of urethral fistula and 4 cases of urethral stenosis. No urethral diverticulum was found. Follow-up checkups in 54 cases for 2 ~36 months (mean, 19 months) showed satisfactory curative results.　Conclusions　Use ofmicrosurgery techniques, proper selection ofsurgicalmethods, and careful surgical performance are helpful to improve the success rate of the surgery. Themicrosurgery is feasible for infants and younger children with hypospadias.

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更新日期/Last Update: 2014-03-03