Application of Staged Island Prepuce Flap Urethral Plate Reconstruction in Severe Hypospadias
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摘要:
目的 研究分期岛状包皮瓣尿道板重建术在重度尿道下裂手术治疗中的临床效果。 方法 回顾性分析2013年11月至2022年3月昆明医科大学第一附属医院治疗的重度尿道下裂患者28例临床资料。按照手术方法的不同，分为分期岛状包皮瓣尿道板重建术式手术组（A组）和传统分期手术（即：一期伸直阴茎，二期尿道成形术）组（B组）。比较2组患者的年龄、手术时间、出血量、术后并发症的发生率，并随访亲属对治疗的满意度。 结果 分期岛状包皮瓣尿道板重建术的13例中，在首次手术时年龄2岁至34岁，尿道缺损长度3.5～6 cm；传统分期手术患者15例, 第1次手术时年龄2岁至27岁，尿道缺损长度 3～6 cm。2组患者的年龄、治疗时间、术中出血量差异无统计学意义（P > 0.05）。分期岛状包皮瓣尿道板重建术手术组术后2例发生尿道瘘，另1例发生阴茎头部尿道破裂。经再次尿道瘘修补/尿道成形治疗。传统分期手术组术后4例发生尿道瘘，2例尿道狭窄和尿道憩室。需经再次手术尿瘘修补术/尿道成形术，尿道扩张术治愈。分期岛状包皮板尿道板重建术组手术成功率为76.9%，传统分期手术组手术成功率为60.0%（P > 0.05）。且分期岛状包皮瓣尿道板重建术较传统分期手术术后满意度更高（P < 0.05）。 结论 分期岛状包皮瓣尿道板重建术已成为分期治愈尿道下裂的重要方法，对重度的尿道下裂术后安全性较好，外观比较满意，并发症发生率低，具有临床应用价值。 Abstract:Objective To study the clinical effect of staged Island prepuce flap urethral plate reconstruction in the treatment of severe hypospadias. Methods Twenty-eight patients with severe hypospadias treated in our hospital from November 2013 to March 2022 were selected for the study. According to the different surgical methods, the patients were divided into two groups: staged island prepuce flap urethral plate reconstruction group （group A） and traditional staged operation （one-stage extension of penis and two-stage urethroplasty） group （group B）. The age, operation time, blood loss, postoperative complications of patients or relatives treatment confidence and cure rate were compared between the 2 groups. Results Thirteen patients were aged from 2 to 34 years at the time of first operation,and the urethral defect length was 3.5-6 cm. Fifteen patients, aged from 2 to 27 years at the time of the first operation, had a urethral defect of 3-6 cm in length. There were no significant differences in age, treatment time, intraoperative blood loss and treatment between the two groups. In the staged island foreskin flap urethral plate reconstruction operation group, 2 cases developed urethral fistula after the operation, and the other 1 case developed urethral rupture at the head of the penis. Re-repair of urethral fistula/urethroplasty. There were 4 cases of urethral fistula and 2 cases of urethral stricture and a urethral diverticulum in the traditional staged operation group. Need to re-operation urethral fistula repair/urethroplasty, urethral dilatation to cure. The surgical success rate of the staged island foreskin plate urethral plate reconstruction surgery group was 76.9%, and the surgical success rate of the traditional staged surgery group was 60.0%. Conclusions Staged Island prepuce flap urethral plate reconstruction has become an important method to cure hypospadias by stages. It has good safety, satisfactory appearance, low complication rate and clinical application value for moderate and severe hypospadias. -
Key words:
- Hypospadias /
- Two-stage surgery /
- Urethroplasty
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图 1 分期岛状包皮瓣尿道板重建术式
A：尿道下裂术前患者的外观特征; B：在切断尿道板并将脱套松解后，在背侧折叠并伸展阴茎; C：在皮瓣卷管缝合后，再成形为一个独立的尿管; D：在完成阴茎体表皮时，在阴茎体下段仍留一小瘘口; E：分期尿道板重建术式，第1期术后外表；F：第二次手术前外貌；G：二次手术作Y字切口；H：二次手术后外貌。
Figure 1. The surgical procedure of staged island prepuce flap urethral plate reconstruction
表 1 分期岛状皮瓣尿道板重建术式治疗组与传统分期手术组的手术情况比较[M（P25，P75）]
Table 1. Comparison of the results between the staged island prepuce flap urethral plate reconstruction group and the traditional staged group [M（P25，P75）]
组别 n 年龄（岁） 出血量（mL） 手术时间（min） 分期岛状包皮瓣尿道板重建术治疗组（A组） 13 8.5（4.0，17.0） 40.00（23.75，50.50） 195.0（129.0，308.5） 传统分期手术组（B组） 15 12.0（8.0，20.0） 55.00（20.00，105.00） 150.0（134.0，235.0） Z −1.005 −0.635 −0.22 P 0.331 0.533 0.983 
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表 2 分期岛状包皮瓣尿道板重建术治疗组与传统分期手术组的并发症发生率比较[n（%）]
Table 2. Comparison of the incidence of complications between the staged island prepuce flap urethral plate reconstruction group and the traditional staged urethroplasty group [n （%）]
组别 n 尿道瘘 尿道狭窄和尿道憩室 阴茎头裂开 成功率（%） 分期岛状皮瓣尿道板重建术治疗组（A组） 13 2（11） 0（13） 1（12） 76.9 传统分期手术组（B组） 15 4（11） 2（13） 0（15） 60.0 χ2 0.526a 1.867a 1.197a 0.914a P 0.655 0.484 0.464 0.435 a = 0.05。
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表 3 重度尿道下裂术后情况满意度比较
Table 3. Comparison of satisfaction of hypospadias between two groups
组别 手术治疗 非常满意 满意 部分满意 不满意 满意率（%） 分期岛状皮瓣尿道板重建术治疗组（A组） 8 2 1 2 84.62 传统分期手术组（B组） 4 2 2 7 53.33 z −2.052 P 0.04* *P < 0.05。
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