摘要
目的:探讨改良尿道板镶嵌尿道成形术,即阴茎头段尿道板镶嵌尿道成形术(Glans Inlay,G-Inlay)在尿道下裂术后阴茎远端尿道瘘修复中的临床可行性及应用效果。方法:收集2020年1月—2024年12月在厦门大学附属妇女儿童医院诊断尿道下裂术后阴茎远端尿道瘘行G-Inlay手术修复患儿。共纳入62例,其中首次手术方式行尿道板纵切卷管尿道成形术(tubularized incised plate,TIP)术式45例(72.58%),Mathieu术式5例(8.06%),Onlay术式6例(9.68%),其他或不详共6例(9.68%)。记录患儿临床随访资料、术后并发症情况、最大尿流率(maximum urinary flow rate,Qmax)及国际尿道下裂客观评分标准(hypospadias objective scoring evalution,HOSE)评分,对结果进行统计学分析。结果:共62例纳入分析,均一期完成手术。患儿平均年龄(51.16±21.67)个月,随访时间6~58个月。平均手术时间(82.23±13.10)min;成形尿道长度8~21mm,平均13.79 mm。平均术前尿道口直径约(2.89±0.87)mm,口冠距(2.42±1.06)mm,存在不同程度尿道口狭窄。手术后平均尿道口直径(5.50±0.76)mm,口冠距(4.19±0.81)mm,较术前均明显增大,差异有统计学意义。术后舟状窝顶点分别至冠状沟背侧中点及腹侧中点的距离接近,尿道口顶点近似位于阴茎头前端正位。术后并发症:尿道瘘6例、尿道狭窄1例,无阴茎头裂开,总成功率为88.71%。术后2周的平均Qmax为(11.36±2.18)mL/s。所有患儿术后尿道口宽敞,均位于阴茎头前端,呈垂直裂隙状,尿线向前,HOSE平均得分为(15.07±0.66)分。结论:G-Inlay手术的改良技术修复儿童尿道下裂术后阴茎远端尿道瘘是安全有效的,该术式手术步骤相对简单,手术效果满意,术后尿流率得到明显改善,且阴茎外观美观,值得推广。
Objective:To investigate the clinical feasibility and application of Glans Inlay graft urethroplasty(Glans Inlay,G-Inlay)in the repair of distal penis urethral fistula after hypospadias surgery.Methods:A total of 62children with G-Inlay surgical repair of distal penile urethral fistula after hypospadias from January 2020to December 2024in our hospital were collected.Among them,the first surgical approach was TIP in 45cases(72.58%),Mathieu in 5cases(8.06%),Onlay preputial flap urethroplasty in 6cases(9.68%),and other or unknown in a total of 6cases(9.68%).The children’s clinical follow-up data,postoperative complications,maximum urinary flow rate and HOSE score were recorded and the results were statistically analyzed.Results:A total of 62cases were included in the analysis,all completed in one stage,with an average age of(51.16±21.67)months and a follow-up period of 6-58months.The operative time was(82.23±13.10)min;the length of reconstructed urethral length was 8-21mm,with a mean of 13.79mm.The mean preoperative diameter of the urinary meatus was about(2.89±0.87)mm,and the distance from meatus to ventral glans corona was(2.42±1.06)mm,with varying degrees of urethral stenosis.After surgery,the diameter of the urinary meatus(5.50±0.76)mm and the distance from meatus to ventral glans corona(4.19±0.81)mm were significantly larger than those before surgery,and the difference was statistically significant.The distance from the distal endpoint of navicular groove to the dorsal or ventral midline point of the glans corona were close after surgery,and the apex of the urethral opening was approximately located at the anterior end of the penile head.Postoperative complications included urethral fistula in 6cases and urethral stricture in 1case,without penile head split.An overall success rate was 88.71%.The mean Qmax at 2weeks postoperatively was(11.36±2.18)mL/s.The postoperative urinary meatus was spacious in all children,located at the tip of the glans and apprearing vertical fissure,with the urethral line moving forward,and the mean HOSE score was(15.07±0.66).Conclusion:The modified technique of the G-Inlay procedure for repairing distal penile urethral fistula after hypospadias in children is safe and effective.This procedure features relatively simple surgical steps,delivers satisfactory outcomes,significantly improves postoperative urinary flow rates,and results in an aesthetically pleasing penile appearance,making it worthy of promotion.
作者
徐波
王寿福
陈海琛
吴永隆
胡杨
XU Bo;WANG Shoufu;CHEN Haichen;WU Yonglong;HU Yang(Department of Pediatric Surgery,Women and Children’s Hospital,School of Medicine,Xiamen University,Xiamen,Fujian,361003,China)
出处
《临床泌尿外科杂志》
2025年第11期1001-1005,共5页
Journal of Clinical Urology
基金
福建省卫生健康科技计划项目(No:2024QNB025)
厦门市科学技术局计划项目(No:3502Z20227298)。
