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目的探寻治疗近端型尿道下裂理想的手术方式。方法88例近端型尿道下裂患者,年龄2～21岁,平均4岁。其中阴茎阴囊交界型59例,阴囊型16例,会阴型13例。采用改良尿道口旁阴茎包皮瓣尿道成形术(改良Koyanagi术)43例,横形带蒂包皮瓣尿道成形术(Duckett术)45例。比较2种术式的手术时间、并发症、再手术率、术后尿瘘修补成功率、术后外观等。结果2种术式手术时间分别为(124±32)min和(179±28)min(P<0．05);尿瘘、尿道狭窄等并发症总发生率为30％(13／43)和64％(29／45),P<0．001;再手术率分别为21％(9／43)和40％(18／45),P>0．05;术后尿瘘修补成功率分别为89％(8／9)和61％(8／13),P=0．178。77例获随访6～39个月,效果满意。亲属对患儿术后外观满意度分别为79％(30／38)和46％(18／39),P<0．01;阴茎旋转扭曲>90°者分别0和19％(7／36)。结论改良Koyanagi术符合解剖生理,优于Duckett术,是较理想的近端型尿道下裂一期修复手术方式。
Objective To explore the ideal surgical approach to the treatment of proximal hypospadias. Methods 88 cases of proximal hypospadias, aged 2 to 21 years old, average 4 years old. Including penis and scrotum junction type 59 cases, scrotum 16 cases, 13 cases of perineal. Forty - three patients underwent urethroplasty (modified Koyanagi operation) with modified urethral penile preputial flap and 45 cases underwent transverse pedicle urethroplasty (Duckett ’s operation). The operative time, complications, rate of reoperation, the success rate of postoperative urinary fistula repair and postoperative appearance were compared. Results The operative time of the two procedures were (124 ± 32) min and (179 ± 28) min, respectively (P <0.05). The total complication rates of urinary fistula and urethral stricture were 30% (13/43) and 64 % (29/45), P <0.001; The rates of reoperation were 21% (9/43) and 40% (18/45) respectively, P> 0.05; the success rates of postoperative urinary fistula repair were 89% (8/9) and 61% (8/13), P = 0.178.77 cases were followed up for 6 to 39 months, with satisfactory results. The relatives’ satisfaction with the postoperative appearance of children was 79% (30/38) and 46% (18/39) respectively, P <0.01; 0 and 19% (7/36) . Conclusion Improved Koyanagi surgery anatomical physiology, better than Duckett surgery, is an ideal proximal hypospadias repair surgery.