摘要
目的：通过与一期 Duckett 术式手术效果进行比较，探讨分期 Duckett 术式治疗重度尿道下裂的应用及价值。方法2009年1月至2014年10月，我们收治重度尿道下裂72例，均为阴茎阴囊交界型或会阴型尿道下裂，患儿第1次手术时年龄2～3岁，平均2.4岁。其中38例采用管形包皮岛状皮瓣法一期尿道成形术，即一期 Duckett 术式，为 A 组，成形尿道长度4～6 cm。34例采用分期手术，一期手术中矫正阴茎下弯后，采用管形包皮岛状皮瓣法成形部分尿道，即分期 Duckett 术式，为 B 组；第一期成形尿道长度为3～4.5 cm；术后1年行二期尿道成形术，成形尿道长度1.5～2.5 cm，两期手术成形尿道总长度4～6 cm。结果两组均获随访，术后随访6个月至5年，平均3.5年，无一例阴茎下弯复发。A 组有7例（7／38，18.5％）术后发生尿瘘。B 组有3例（3／34，8.8％）术后发生尿瘘，均出现在二期尿道成形术后。A 组有4例出现尿道狭窄（4／38，10.5％），B 组1例出现尿道狭窄（1／34，2.9％）。A组有4例出现尿道憩室（4／38，10.5％），B 组无一例尿道憩室发生。A 组手术成功率为60.5％，B 组手术成功率为88.3％，差异有统计学意义（P ＝0．008）。结论与一期 Duckett 术式相比，分期 Duckett术式治疗重度尿道下裂，术后并发尿瘘、尿道狭窄和尿道憩室少。分期 Duckett 术式有效降低了重度尿道下裂的手术难度和并发症的发生率，提高了复杂尿道下裂的疗效，具有较好的临床应用价值。
Objetive To explore the application value of two-stage Duckett’s procedure for severe hypo-spadias. Methods From January 2009 to October 201 4,we retrospectively analyzed 72 cases of severe hypos-padias undergoing single and two-stage Duckett’s urethroplasty.The mean age was 2.4 （2 ~3）years during the first operation.Hypospadias was type III or IV.In group A,38 cases with tubularized preputial island flap underwent single-stage Duckett’s urethroplasty.Pedicled island flap length was 4 ~6 cm with a width of 1 .2 cm.Duckett tube was transferred into ventral side of penis.In group B,another 34 cases underwent two-stage Duckett’s urethroplasty.Chordee of penis was corrected only with tubularized preputial island flap forming par-tial urethra.After straightening penis,pedicled island flap length was 3 ~4.5 cm with a width of 1 .2 cm.Prox-imal Duckett tube opening and urethral meatus were 1 .5 ~2.5 cm apart.And second urethroplasty was per-formed 1 year later. Results The average follow-up period was 3.5 （0.5 ~5）years.Neither group had no recurrence of penis chordee.In group A,7 cases （1 8.5%）developed postoperative fistula.In group B,3 cases （8.8%）had fistula after second urethroplasty.In group A,4 cases of urethral stricture had a stricture rate of 1 0.5%.In group B,1 case of urethral stricture had a stricture rate of 2.9%.In group A,there were 4 cases of urethral diverticulum.Significant inter-group differences existed in the rates of urethral fistula,urethral stricture and urethral diverticulum.The success rate of operation was 60.5% in group A versus 88.3% in group B.The inter-group difference of success rate was statistically significant （P =0.008）. Conclusions As compared＆amp;nbsp;with single-stage Duckett’s procedure,lower rates of postoperative urinary fistula,urethral stricture and divertic-ulum may be achieved for two-stage Duckett’s procedure.The latter is more preferable for severe hypospadias.
出处
《临床小儿外科杂志》
CAS
2016年第5期439-442,459,共5页
Journal of Clinical Pediatric Surgery
基金
北京市医院管理局"登峰"人才培养计划(项目号:DFL20151102)
