摘要
目的 通过分析加盖包皮岛状皮瓣尿道成形术（Onlay手术）治疗尿道下裂的临床疗效,探讨手术适应证范围和并发症特点.方法 回顾性分析2005年3月至2012年9月广西医科大学第一附属医院采用Onlay手术治疗的尿道下裂51例,年龄2～12岁,中位年龄4.3岁.其中首次手术43例,再次手术8例.采用单因素分析阴茎下曲程度、尿道缺损长度、手术次数、阴茎头大小对手术成功率的影响.结果 全组手术成功率82.4％（42/51例）,尿瘘7例,6例已经修补治愈,1例自行愈合.尿道外口裂开1例.阴茎下曲矫正不良1例.比较影响手术成功率的各种因素,其中轻中度阴茎下曲、尿道缺损长度、手术次数对手术成功率的影响差异均无统计学意义（x2=0.249、0.287、1.208,P均＞0.05）.阴茎头大小对手术成功率有显著影响（x2=3.393,P＜0.05）.结论 Onlay手术适用于大多数冠状沟型和阴茎体前端型病例,对于近端型明显下曲的病例需慎重考虑,因为可能导致术后阴茎下曲矫正不良.Onlay手术也适用于部分再次手术病例,但需要灵活设计岛状皮瓣.尿瘘仍然是Onlay手术最多见的并发症,尤其是阴茎头圆而小的病例.
Objective To investigate the indications and complications of onlay island flap urethroplasty in hypospadias.Methods Retrospective analysis 51 cases who received the onlay urethroplasty from Mar.2005 to Sep.2012 at the First Affiliated Hospital of Guangxi Medical University.Their ages were from 2 years to 12 years,the median age was 4 years and 3 months.Forty-three cases received the operation for the first time,8 cases were re-operation.The prepuce island flaps were implemented in all cases.Factors which contributed to the successful operation ratio were compared,such as the levels of penile curvature,the lengths of urethral defects,first operation or reoperation,the size of glans.Results The operation achievement ratio was 82.4％ （42/51 cases）.There were 7 cases urethrocutaneous fistula（6 cases were then cured by reoperation,1 case healed naturally）.One case had urinary meatus had retraction.There was another case with persisting penile curvature.Some differences in factors had no statistical significance,such as the levels of penile curvature,the lengths of urethral defects,first operation or reoperation （x2 =0.249,0.287,1.208 ; all P ＞ 0.05）.The difference in glans size had statistical significance （x2 =3.393,P ＜ 0.05）.Conclusions Onlay urethroplasty was suitable for the cases of coronary sulcus of penis and extremitas anterior penis,but for proximal cases,this therapy must be applied very carefully because of persisting penile curvature.For some reconstruction cases,Onlay urethroplasty was suitable,but the island flap must be designed flexibly.Urethrocutaneous fistula was the most complication,especially in some small flat glans.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2014年第2期151-153,共3页
Chinese Journal of Applied Clinical Pediatrics
基金
广西壮族自治区卫生厅计划课题资助（桂卫Z2013003）
