尿道下裂是泌尿科常见的先天性疾病之一,均需手术治疗,虽手术方法很多.但目前主要采用两种方法,一是应用阴茎、阴囊皮肤成型尿道;二是利用膀胱粘膜,羊膜等移植物作尿道替代物成型尿道.我院1979～1990年共收治78例先天性尿道下裂患者,因手术方法不断改进,成功率由原来63.2%提高到94.8%,本文作一回顾性分析.1 临床资料本组78例最初19例系采取传统的分期手术方法.其后20例采用膀胱粘膜替代尿道.最后39例则采用阴囊纵隔带血管蒂皮瓣行Ⅰ期尿道成型术;年龄6～26岁,平均12.7岁;尿道下裂的临床分型及手术方式见表1,阴茎切口7～10天拆线,平均9天;尿流改流方式均为耻骨上膀胱造瘘,拆线后2～7天试行排尿,通畅后拔除造瘘管,平均拔管时间为术后14天.13例术后并发症详见表2,其中4例细小瘘口经延期拔除造瘘管后愈合,3例尿道口及吻合口狭窄经尿道扩张后排尿通畅.其余5例经二次尿瘘修补或再次成形手术治愈.一次手术成功率为83.3%,总成功率为93.6%.2 讨论2.1 治疗方法的比较 先天性尿道下裂是一种常见的先天性发育异常,发病率为1/300,诊断多无困难,重要的是采取何种治疗方式既减少患者痛苦,又符合尿道生理要求,成功率又高.本组将三种术式进行 Hypospadias is one of the common urological congenital diseases, require surgical treatment, although many surgical methods.But currently mainly used two methods, one is the application of the penis, scrotal skin urethra formation; the second is the use of the bladder mucosa, amniotic membrane, etc. Graft as a urethral substitute for the formation of the urethra.Our hospital from 1979 to 1990 were treated 78 cases of congenital hypospadias patients, due to continuous improvement of surgical methods, the success rate from 63.2% to 94.8%, this retrospective analysis. 1 The clinical data of 78 cases of the first 19 cases of the Department of traditional staging surgery, followed by 20 cases of bladder mucosa to replace the urethra. The last 39 cases were scrotal mediastinal pedicle flap pedicle Ⅰ urethroplasty; age 6 ~ 26 years old, an average of 12.7 years old; the clinical classification of hypospadias and surgical methods shown in Table 1, 7-10 days of incision stitches, an average of 9 days; urinary flow modification methods are suprapubic bladder fistula, stitches 2 to 7 days of trial urination, unobstructed fistula removed, the average extubation time was 14 days after operation .13 cases of postoperative complications shown in Table 2, of which 4 cases of small fistula after prolonged removal of fistula healing, 3 cases Urinary tract and anastomotic stenosis urinary tract patency by urethral dilatation. The remaining 5 cases were repaired by secondary urinary fistula or reshaping surgery.A successful rate was 83.3%, the total success rate was 93.6% .2 Discussion 2.1 Comparison of treatment methods Congenital hypospadias is a common congenital dysplasia , The incidence rate of 1/300, no more diagnosis, the important thing is to take what kind of treatment not only reduce the patient’s pain, but also meet the physiological requirements of the urethra, the success rate is high.This group of three surgical procedures