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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。
Objective To evaluate the application and value of staging Duckett procedure in the treatment of severe hypospadias by comparing with the Duckett operation. Methods From January 2009 to October 2014, we treated 72 cases of severe hypospadias, all of which were penile scrotal junction or perineal hypospadias. The first operation of children was 2-3 years old with an average of 2.4 years old. Thirty-eight cases were treated by the first stage urethroplasty with a tube-shaped preputial island flap, a stage Duckett procedure, which was performed in group A. The length of the formed urethra ranged from 4 to 6 cm. Thirty-four cases were treated by staging surgery. One stage of operation was performed to correct the penile curvature. The part of the urethra was formed by the tubular preputial skin flap method, which was divided into group B by stage Duckett operation. The length of the first stage urethra was 3 ~ 4.5 cm . The second stage urethroplasty was performed one year after operation. The length of the formed urethra was 1.5-2.5 cm. The total length of the two forms of urethra was 4-6 cm. Results Both groups were followed up for 6 months to 5 years after operation, with an average of 3.5 years. No recurrence of penile recurrence was found. A group of 7 patients (7 / 38,18.5%) urinary fistula occurred. In group B, 3 cases (3 / 34.8.8%) developed fistula after operation, both of which occurred after stage II urethroplasty. In group A, there were 4 cases of urethral stricture (4 / 38,10.5%), 1 case of urethral stricture (1 / 34,2.9%) in group B. In group A, there were 4 cases of urethral diverticulum (4/38, 10.5%), and none of group B had urethral diverticulum. The success rate of operation in group A was 60.5% and in group B was 88.3%, the difference was statistically significant (P = 0.008). Conclusions Compared with a Duckett procedure, staging Duckett operation can treat severe hypospadias, postoperative urinary fistula, urethral stricture and urethral diverticulum. Stage Duckett operation effectively reduces the difficulty of severe hypospadias operation and the incidence of complications, improve the curative effect of complex hypospadias, has a good clinical value.