中国修复重建外科杂志

中国修复重建外科杂志

阴茎头海绵体减容技术在中-重度尿道下裂修复手术阴茎头成形中的应用

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目的 探讨阴茎头海绵体减容技术在中-重度尿道下裂修复手术阴茎头成形中的应用及疗效。 方法 回顾性分析 2015 年 11 月—2017 年 5 月,103 例行尿道下裂修复术中采用阴茎头海绵体减容技术行阴茎头成形的中-重度尿道下裂患儿(减容组)临床资料;以同期未采用阴茎头减容技术行阴茎头成形的 88 例患儿作为对照组。两组患儿术前阴茎头横径、阴茎腹侧头冠距比较,差异均无统计学意义(t=1.652,P=0.152;t=1.653,P=0.077)。记录两组成形尿道长度以及随访期间阴茎头裂开以及尿道皮肤瘘等相关并发症发生情况,检测术后 3 个月最大尿流率。 结果 减容组术中成形尿道长度为(35.51±7.79)mm;完成阴茎伸直后尿道开口位置:阴茎体近段型 24 例、阴囊及会阴型 79 例。对照组术中成形尿道长度为(32.17±6.37)mm;完成阴茎伸直后尿道开口位置:阴茎体近段型 21 例、阴囊及会阴型 67 例;两组病例完成阴茎伸直后尿道开口位置分布情况差异无统计学意义(χ2=0.008,P=0.920)。术后两组均获随访,随访时间 6~12 个月,平均 9 个月。术后减容组发生尿道皮肤瘘 3 例、阴茎头裂开 2 例、尿道外口狭窄 3 例,并发症发生率为 7.8%;对照组发生尿道皮肤瘘 7 例、阴茎头裂开 3 例、尿道外口狭窄 4 例,并发症发生率为 15.9%;两组并发症发生率比较,差异有统计学意义(χ2=4.027,P=0.040)。两组患者阴茎外观满意,尿道外口呈裂隙样,接近正常尿道外口外观。术后 3 个月,减容组最大尿流率为(6.23±0.54)mL/s,对照组为(5.44±0.92)mL/s,比较差异有统计学意义(t=1.653,P=0.000)。 结论 阴茎头海绵体减容技术在需切断尿道板的中-重度尿道下裂修复术中,能减少术后阴茎头裂开、尿道瘘及尿道外口狭窄等并发症发生风险,提高尿道下裂修复成功率及术后满意度。

Objective To investigate the application of cavernosum reduction technology in glanuloplasty during the repair of moderate-severe hypospadias and evaluate the effectiveness. Methods The clinical data of 192 patients with moderate-severe hypospadias between November 2015 and May 2017 were retrospectively analyzed. Among them, 103 patients were treated with the cavernosum reduction technology in glanuloplasty during the repair (observation group), 88 patients were treated with repair and glanuloplasty without the cavernosum reduction technology (control group). There was no significant difference in maximum transverse diameter of glans and the height of glans between 2 groups (t=1.652, P=0.152; t=1.653, P=0.077). The length of reconstructed urethra, complications (e.g. glans dehiscence and fistula), and the maximum flow rate (Qmax) at 3 months after operation in 2 groups were recorded. Results The length of reconstructed urethra were (35.51±7.79) mm in observation group and (32.17±6.37) mm in control group. In observation group, the meatus location after the correction of chordee was proximal in 24 cases and scrotum-perineum in 79 cases. In control group, the meatus location after the correction of chordee was proximal in 21 cases and scrotum-perineum in 67 cases. There was no significant difference in the meatus location between 2 groups (χ2=0.008, P=0.920). All patients were followed up 6-12 months after operation (mean, 9 months). There were 3 cases of urethral fistula, 2 cases of glans dehiscence, and 3 cases of urethral orifice stricture in observation group, with the incidence of complications of 7.8%. There were 7 cases of urethral fistula, 3 cases of glans dehiscence, and 4 cases of urethral orifice stricture in control group, with the incidence of complications of 15.9%. There was a significant difference in the incidence of complications between 2 groups (χ2=4.027, P=0.040). The appearance of the penis was satisfactory, and the urethral orifice was fissured, which was close to the appearance of the normal urethral orifice. At 3 months after operation, the maximal flow rates were (6.23 ± 0.54) mL/s in observation group and (5.44±0.92) mL/s in control group. There was significant difference in the maximum flow rate between 2 groups (t=1.653, P=0.000). Conclusion Cavernosum reduction technology being applied in the repair of moderate-severe hypospadias can reduce the probability of glans dehiscence, urethral fistula, urethrostenosis, and other postoperative complications, and improve the success and satisfaction of surgery.

关键词: 尿道下裂; 阴茎头海绵体减容技术; 阴茎头成形

Key words: Hypospadias; cavernosum reduction technology; glanuloplasty

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