目的 探讨应用口腔黏膜预植尿道板分期治疗残废型尿道下裂的效果。 方法 回顾性分析2019年3月至2023年3月遵义市第一人民医院小儿外科收治的残废型尿道下裂患儿的临床资料。手术方式均采用口腔黏膜预植尿道板分期治疗，即一期手术行阴茎伸直、口腔黏膜预植尿道板，二期手术行尿道成形。术后随访观察尿道板存活、尿瘘、尿道裂开、尿道憩室、尿道狭窄、阴茎下弯复发、阴茎外观及排尿情况。 结果 纳入12例男性患儿，年龄5岁1个月至14岁，中位年龄8岁2个月。12例患儿入院前有2～4次尿道下裂手术史，平均3.2次，所有病例均伴有中、重度阴茎下弯和包皮缺乏，其中尿道裂开5例，多处尿瘘3例，尿道狭窄4例。所有患儿术后随访6～36个月，平均25个月。一期术后发生预植尿道板部分感染、失活1例，经高压氧治疗及局部换药后愈合；二期术后发生尿瘘2例，经再次尿瘘修补术后治愈；其他患儿无尿道裂开、尿道憩室、尿道狭窄、阴茎下弯复发，阴茎外观无臃肿，尿道开口位于阴茎头正位，呈纵向裂隙状，排尿通畅、尿线连续。 结论 口腔黏膜预植尿道板分期治疗残废型尿道下裂效果满意，是一种安全、可行的有效方法。 Objective To investigate the effect of staged operations with oral mucosa preimplantation urethral plate in the treatment of crippled hypospadias. Methods The clinical records of patients with crippled hypospadias which were treated in the First People’s Hospital of Zunyi from March 2019 to March 2023 were retrospectively reviewed. Staged operations with oral mucosa preimplantation urethral plate were applied to all patients. The survival condition of preimplantation urethral plate, urethrocutaneous fistula, urethral dehiscence, urethral diverticulum, urethrostenosis, residual chordee, the appearance of penis and urinating condition were observed. Results Twelve male children were enrolled, ranging in age from 5 years and 1 month to 14 years, with a median age of 8 years and 2 months. All of these patients had 2 to 4 times of urethroplasty surgeries with an average time of 3.2. All patients suffered from moderate to severe chordee and lack of prepuce, including 5 patients with urethral dehiscence, 3 cases with multiple urethrocutaneous fistulas and 4 cases with urethrostenosis. All patients were followed 6 to 36 months after surgery with an average of 25 months. One patient suffered from infection of preimplantation urethral plate after the first stage operation was cured by hyperbaric oxygen therapy and local dressing. Two patients complained of urethrocutaneous fistula after the second stage operation were cured by fistulectomy. No urethral dehiscence, urethral diverticulum, urethrostenosis or residual chordee was observed in other patients. Penile appearance was not bloated and the longitudinal slit urethral orifice was located in the head of the penis. Urination was smooth and the urine line was continuous. Conclusion Staged operation with oral mucosa preimplantation urethral plate is an effective and safe method for the treatment of crippled hypospadias.
Treatment of crippled hypospadias by staged operation with oral mucosa preimplantation urethral plate
Objective To investigate the effect of staged operations with oral mucosa preimplantation urethral plate in the treatment of crippled hypospadias. Methods The clinical records of patients with crippled hypospadias which were treated in the First People’s Hospital of Zunyi from March 2019 to March 2023 were retrospectively reviewed. Staged operations with oral mucosa preimplantation urethral plate were applied to all patients. The survival condition of preimplantation urethral plate, urethrocutaneous fistula, urethral dehiscence, urethral diverticulum, urethrostenosis, residual chordee, the appearance of penis and urinating condition were observed. Results Twelve male children were enrolled, ranging in age from 5 years and 1 month to 14 years, with a median age of 8 years and 2 months. All of these patients had 2 to 4 times of urethroplasty surgeries with an average time of 3.2. All patients suffered from moderate to severe chordee and lack of prepuce, including 5 patients with urethral dehiscence, 3 cases with multiple urethrocutaneous fistulas and 4 cases with urethrostenosis. All patients were followed 6 to 36 months after surgery with an average of 25 months. One patient suffered from infection of preimplantation urethral plate after the first stage operation was cured by hyperbaric oxygen therapy and local dressing. Two patients complained of urethrocutaneous fistula after the second stage operation were cured by fistulectomy. No urethral dehiscence, urethral diverticulum, urethrostenosis or residual chordee was observed in other patients. Penile appearance was not bloated and the longitudinal slit urethral orifice was located in the head of the penis. Urination was smooth and the urine line was continuous. Conclusion Staged operation with oral mucosa preimplantation urethral plate is an effective and safe method for the treatment of crippled hypospadias.
万方数据
