保留尿道板治疗尿道下裂手术效果评价及影响因素分析
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摘要
第一部分保留尿道板治疗尿道下裂
手术效果评价
目的:由于修复尿道下裂手术难度较大,手术方式多种多样,疗效参差不齐。本研究通过回顾性分析,分别对保留与横断尿道板治疗尿道下裂的手术病例进行分析,观察保留尿道板手术治疗尿道下裂的效果,总结手术经验。
方法:2000年1月～2009年8月期间,收治尿道下裂初治病人560例,均接受手术治疗,年龄2～14岁(中位数3.56)。将病人随机分成两组,A组260例,原则上采用传统手术方式,即横断尿道板手术方式做对照;B组300例,采用保留尿道板手术方式治疗。分别根据尿道下裂患儿的Barcat分型、阴茎下弯程度对两组病人进行对照分析,以了解两种手术方式治疗尿道下裂的差异程度。
结果:1.通过对不同方式的分组分析,保留尿道板治疗尿道下裂手术组治愈率明显高于横断尿道板治疗尿道下裂手术组治愈率,手术效果有统计学差异(P=0.000)。2.对于前型、中问型和后型尿道下裂,保留尿道板手术组与横断尿道板手术组之间的治愈率均存在显著性差异(P=0.000,P=0.000,P=0.002)。3.对于轻度、中度和重度阴茎下弯,保留尿道板手术组与横断尿道板手术组之间的治愈率之间的差异均有统计学意义(P=0.000,P=0.000,P=0.001)。
结论:采用保留尿道板手术适用于大多数小儿尿道下裂的治疗,由于保留了尿道板的完整性,新建尿道与原尿道连接处不形成环状吻合口,手术治愈率明显高于横断尿道板手术组成功率。
第二部分保留尿道板治疗尿道下裂手术效果影响因素分析
目的:通过对保留尿道板手术治疗尿道下裂的病例进行回顾性分析,对影响其手术效果的诸多因素进行研究,分析出其主要影响因素,以期在以后治疗小儿尿道下裂的手术中提高手术治愈率。
方法:2005年8月～2009年8月期间,对选取尿道下裂初治病人300例,均采用保留尿道板手术治疗,年龄2～14岁(中位数3.85)。分别根据患儿的不同年龄、阴茎下弯程度、Barcat分型、手术方式、尿道不同覆盖材料等对手术效果的影响,对其进行单因素分析,分析出影响手术治愈率的因素。
结果:1.通过对多种因素的分析,不同年龄组的手术效果无统计学差异,阴茎下弯程度、手术方式、尿道不同覆盖材料、Barcat分型等影响因素对手术效果都有统计学差异(P＜0.05)。2.前型与后型尿道下裂对尿道瘘发生率和尿道狭窄发生率的影响差异有统计学意义(P=0.005)。3.轻、中度阴茎下弯和重度阴茎下弯手术组病例尿道瘘和尿道狭窄的发生率存在显著性差异(P=0.000,P=0.002)。4.根据手术方式的不同,尿道板纵切卷管尿道成形术与尿道口基底皮瓣法之间尿道瘘和尿道狭窄的发生率存在显著性差异(P=0.003)。5.两种肉膜覆盖技术方式对术后尿道瘘和尿道狭窄的影响有显著性差异(P=0.031)。
结论:1.采用保留尿道板手术效果不受尿道下裂年龄大小的影响;2.保留尿道板手术治疗前型尿道下裂手术治愈率明显高于后型尿道下裂;3.治疗轻、中度阴茎下弯的尿道下裂明显优于重度下弯的尿道下裂;4.在诸多手术方式中,尿道板纵切卷管法明显优于尿道口基底皮瓣法治疗尿道下裂;5.通过转移背侧包皮肉膜组织覆盖新建尿道治愈率高于尿道板旁残存的尿道海绵体和肉膜组织覆盖新建尿道。
PART I Clinical Evaluation of Preserving the Urethral Plate Urethroplasty in Hypospadias Surgery
Objective: To analyze the differences of preserving and cross-sectional urethral plate in hypospadias surgery through retrospective analysis, and to observe the curative effect of the preserving urethral plate.
Methods: 560 hypospadias patients (2-14 years old, M=3.56) who received the first operation from January 2000 to August 2009 were chosen. All patients were divided into two groups randomly. There were 260 patients in A group and 300 patients in B group. Patients in A group received cross-sectional urethral plate urethroplasty which belongs to traditional surgery. Patients in B group received the preserving urethral plate urethroplasty. The effects of both of the urethroplastys in patients were analyzed according to the Barcat sub-type and degree of penile bend respectively.
Results: 1. The cure rate of patients in the preserving urethral plate urethroplasty group was significantly higher than that in the cross-sectional urethral plate urethroplasty group (P=0.000). 2. There were significant differences between the cure rate of patients in preserving and cross-sectional urethral plate urethroplasty in all the three kinds of Barcat hypospadias sub-type (the former type, intermediate type and post-hypospadias) patients respectively (P=0.000, P=0.000, P=0.002). 3. There were significant differences between the cure rate of preserving and cross-sectional urethral plate urethroplasty in different degree of chordee of penis group respectively (mild: P=0.000, moderate: P=0.000, severe: P=0.001).
Conclusion: The preserving urethral plate urethroplasty is suitable for most children with hypospadias. Because of the integrity of the urethral plate, there wasn't circular anastomotic stoma in the junction of the new urethra and the primary urethra, and the cure rate of the preserving urethral plate urethroplasty is higher than that of the cross-sectional urethral plate urethroplasty.
PART II Analysis of the Related Factors of Preserving the Urethral Plate Urethroplasty in Hypospadias Surgery
Objective: To study the related factors of preserving the urethral plate urethroplasty in hypospadias surgery through retrospective analysis and to find the main factors contributing to the cure rate.
Methods: 300 hypospadias patients (2-14 years old, 3.85) who received the first survery therapy between August 2005 and August 2009 were chosen. All of the patients adopted preserving the urethral plate urethroplasty. The Chi-squre test was used to analyzed the effects of surgery according to different factors including age, degree of chordee of penis, Barcat typing, surgical method and mulch materials of urinary tract, finding the main factors that influenced the cure rate.
Results: 1.There was no significant difference between the cure rate of patients in different age groups, but there was significant difference between the cure rate in different degree of penile bending, Barcat sub-type, surgical method and mulch materials of urinary tract respectively (P<0.05) . 2. The incidence rate of urethral fistula and ankylurethria had significant difference in pro-type and post-type hypospadias patients (P=0.005). 3. The incidence rates of urethral fistula and ankylurethria in different degrees of chordee of penis groups had significant differences (P=0.000, P=0.002). 4. There was significant difference (P=0.003) between the incidence rates of urethral fistula and ankylurethria in Snodgrass and Mathieu urethroplasty. 5. There was significant difference between the incidence rates of urethral fistula and ankylurethria in surgery with different mulch materials of urinary tract (P=0.031).
Conclusions: 1. Age had no influence on cure rate in preservation of urethral plate urethroplasty in children with hypospadias. 2. Urethral fistula is the major postoperative complications. The cure rate of preservation of urethral plate urethroplasty in pro-type hypospadias patients was higher than that in post-type hypospadias patients. 3. The effect of preservation of urethral plate urethroplasty was better in hypospadias patients with mild and moderate chordee of penis than patients with severe chordee of penis. 4. In different preservation of urethral plate urethroplastys, Snodgrass is superior to Mathieu. 5. When covering the new urethra, the dorsal skin membrane is better than residual cavernous body of urethra and membrana carnosa beside urethral plate.
手术效果评价
目的:由于修复尿道下裂手术难度较大,手术方式多种多样,疗效参差不齐。本研究通过回顾性分析,分别对保留与横断尿道板治疗尿道下裂的手术病例进行分析,观察保留尿道板手术治疗尿道下裂的效果,总结手术经验。
方法:2000年1月～2009年8月期间,收治尿道下裂初治病人560例,均接受手术治疗,年龄2～14岁(中位数3.56)。将病人随机分成两组,A组260例,原则上采用传统手术方式,即横断尿道板手术方式做对照;B组300例,采用保留尿道板手术方式治疗。分别根据尿道下裂患儿的Barcat分型、阴茎下弯程度对两组病人进行对照分析,以了解两种手术方式治疗尿道下裂的差异程度。
结果:1.通过对不同方式的分组分析,保留尿道板治疗尿道下裂手术组治愈率明显高于横断尿道板治疗尿道下裂手术组治愈率,手术效果有统计学差异(P=0.000)。2.对于前型、中问型和后型尿道下裂,保留尿道板手术组与横断尿道板手术组之间的治愈率均存在显著性差异(P=0.000,P=0.000,P=0.002)。3.对于轻度、中度和重度阴茎下弯,保留尿道板手术组与横断尿道板手术组之间的治愈率之间的差异均有统计学意义(P=0.000,P=0.000,P=0.001)。
结论:采用保留尿道板手术适用于大多数小儿尿道下裂的治疗,由于保留了尿道板的完整性,新建尿道与原尿道连接处不形成环状吻合口,手术治愈率明显高于横断尿道板手术组成功率。
第二部分保留尿道板治疗尿道下裂手术效果影响因素分析
目的:通过对保留尿道板手术治疗尿道下裂的病例进行回顾性分析,对影响其手术效果的诸多因素进行研究,分析出其主要影响因素,以期在以后治疗小儿尿道下裂的手术中提高手术治愈率。
方法:2005年8月～2009年8月期间,对选取尿道下裂初治病人300例,均采用保留尿道板手术治疗,年龄2～14岁(中位数3.85)。分别根据患儿的不同年龄、阴茎下弯程度、Barcat分型、手术方式、尿道不同覆盖材料等对手术效果的影响,对其进行单因素分析,分析出影响手术治愈率的因素。
结果:1.通过对多种因素的分析,不同年龄组的手术效果无统计学差异,阴茎下弯程度、手术方式、尿道不同覆盖材料、Barcat分型等影响因素对手术效果都有统计学差异(P＜0.05)。2.前型与后型尿道下裂对尿道瘘发生率和尿道狭窄发生率的影响差异有统计学意义(P=0.005)。3.轻、中度阴茎下弯和重度阴茎下弯手术组病例尿道瘘和尿道狭窄的发生率存在显著性差异(P=0.000,P=0.002)。4.根据手术方式的不同,尿道板纵切卷管尿道成形术与尿道口基底皮瓣法之间尿道瘘和尿道狭窄的发生率存在显著性差异(P=0.003)。5.两种肉膜覆盖技术方式对术后尿道瘘和尿道狭窄的影响有显著性差异(P=0.031)。
结论:1.采用保留尿道板手术效果不受尿道下裂年龄大小的影响;2.保留尿道板手术治疗前型尿道下裂手术治愈率明显高于后型尿道下裂;3.治疗轻、中度阴茎下弯的尿道下裂明显优于重度下弯的尿道下裂;4.在诸多手术方式中,尿道板纵切卷管法明显优于尿道口基底皮瓣法治疗尿道下裂;5.通过转移背侧包皮肉膜组织覆盖新建尿道治愈率高于尿道板旁残存的尿道海绵体和肉膜组织覆盖新建尿道。
PART I Clinical Evaluation of Preserving the Urethral Plate Urethroplasty in Hypospadias Surgery
Objective: To analyze the differences of preserving and cross-sectional urethral plate in hypospadias surgery through retrospective analysis, and to observe the curative effect of the preserving urethral plate.
Methods: 560 hypospadias patients (2-14 years old, M=3.56) who received the first operation from January 2000 to August 2009 were chosen. All patients were divided into two groups randomly. There were 260 patients in A group and 300 patients in B group. Patients in A group received cross-sectional urethral plate urethroplasty which belongs to traditional surgery. Patients in B group received the preserving urethral plate urethroplasty. The effects of both of the urethroplastys in patients were analyzed according to the Barcat sub-type and degree of penile bend respectively.
Results: 1. The cure rate of patients in the preserving urethral plate urethroplasty group was significantly higher than that in the cross-sectional urethral plate urethroplasty group (P=0.000). 2. There were significant differences between the cure rate of patients in preserving and cross-sectional urethral plate urethroplasty in all the three kinds of Barcat hypospadias sub-type (the former type, intermediate type and post-hypospadias) patients respectively (P=0.000, P=0.000, P=0.002). 3. There were significant differences between the cure rate of preserving and cross-sectional urethral plate urethroplasty in different degree of chordee of penis group respectively (mild: P=0.000, moderate: P=0.000, severe: P=0.001).
Conclusion: The preserving urethral plate urethroplasty is suitable for most children with hypospadias. Because of the integrity of the urethral plate, there wasn't circular anastomotic stoma in the junction of the new urethra and the primary urethra, and the cure rate of the preserving urethral plate urethroplasty is higher than that of the cross-sectional urethral plate urethroplasty.
PART II Analysis of the Related Factors of Preserving the Urethral Plate Urethroplasty in Hypospadias Surgery
Objective: To study the related factors of preserving the urethral plate urethroplasty in hypospadias surgery through retrospective analysis and to find the main factors contributing to the cure rate.
Methods: 300 hypospadias patients (2-14 years old, 3.85) who received the first survery therapy between August 2005 and August 2009 were chosen. All of the patients adopted preserving the urethral plate urethroplasty. The Chi-squre test was used to analyzed the effects of surgery according to different factors including age, degree of chordee of penis, Barcat typing, surgical method and mulch materials of urinary tract, finding the main factors that influenced the cure rate.
Results: 1.There was no significant difference between the cure rate of patients in different age groups, but there was significant difference between the cure rate in different degree of penile bending, Barcat sub-type, surgical method and mulch materials of urinary tract respectively (P<0.05) . 2. The incidence rate of urethral fistula and ankylurethria had significant difference in pro-type and post-type hypospadias patients (P=0.005). 3. The incidence rates of urethral fistula and ankylurethria in different degrees of chordee of penis groups had significant differences (P=0.000, P=0.002). 4. There was significant difference (P=0.003) between the incidence rates of urethral fistula and ankylurethria in Snodgrass and Mathieu urethroplasty. 5. There was significant difference between the incidence rates of urethral fistula and ankylurethria in surgery with different mulch materials of urinary tract (P=0.031).
Conclusions: 1. Age had no influence on cure rate in preservation of urethral plate urethroplasty in children with hypospadias. 2. Urethral fistula is the major postoperative complications. The cure rate of preservation of urethral plate urethroplasty in pro-type hypospadias patients was higher than that in post-type hypospadias patients. 3. The effect of preservation of urethral plate urethroplasty was better in hypospadias patients with mild and moderate chordee of penis than patients with severe chordee of penis. 4. In different preservation of urethral plate urethroplastys, Snodgrass is superior to Mathieu. 5. When covering the new urethra, the dorsal skin membrane is better than residual cavernous body of urethra and membrana carnosa beside urethral plate.
引文
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[45]Elder JS,Ducker JW,Snyder HM,et al.Onlay island flap in the repair of mid and distal penile lrypospadias without chordee.J Urol,1987,138:376-379
[46]Snodgrass WT,Lorenzo A.Tubularized,incised-plate urethroplasty for proximal hypospadias.BJU Internal,2002,89:90-93
[47]Borer JC,Bauer SB,Peters CA,et al.Tubularized,incised plate urethroplasty:expanded use in primary and repeat surgery for hypospadias.J Urol,2001,165:581-585
[1]Baskin LS.Hypospadias an durethral development.J Urol,2000,163,951-956
[2]吴艳乔,王艳萍,朱军,等.国人尿道下裂的流行病学特征.中华泌尿外科杂志,1997,18,753-757
[3]贺厚光.尿道下裂病因学研究进展.国外医学泌尿系统分册,2004,24,296-299
[4]黄澄如.主编,小儿泌尿外科学.第1版,济南:山东科学技术出版社,1996,180-202
[5]Hayashi Y,Kojima Y.Current concepts in hypospadias surgery.Int J Urol.2008,15:651-664
[6]Koevara R,Dvoracek J.In lay- onlay flap urethroplasty for hypospadias andure thrall structure repair.J Urol,1997,158:2142-2145
[7]Baskin LS.尿道下裂的病因及解剖学研究.中华小儿外科杂志,2000,21:62-63
[8]谢向辉,黄澄如,孙宁,等.保留尿道板手术在尿道下裂治疗中的应用.中华小儿外科杂志,2003,24:136-138
[9]何大维,李旭良,魏光辉,等.尿道板在尿道下裂一期手术中的应用.中华泌尿外科杂志,2003,24:854
[10]马代明,戴建东.Snodgrass尿道成形术治疗尿道下裂的体会.中国妇幼保健,2007,22:897-898
[11]张旭辉,王计文.Snodgrass尿道成形术在小儿尿道下裂中的应用.临床小儿外科杂志,2005,4:327-329
[12]阮双岁,葛琳娟,陆毅群,等.尿道下裂不同术式的疗效评价.中华泌尿外科杂志,2001,22:364-366
[13]Baskin S,AliErol,Ying WuLi,et al.Anatomical studies of hypospadias.J Urol,1998,160:1108-1115
[14]Duckett JW.MAGPI(meatoplasty and glanuloplasty):a procedure for subcoronal hypospadias.Urol Clin North Am,1981,8:513-519
[15]翟成琦,周德贵,赵成辉,等.尿道前移治疗尿道下裂.中华小儿外科杂志,1998.19:299
[16]孟凡全,公培云.改良式MAGPI氏法治疗前尿道狭窄.实用医技志,2007,14:768-769
[17]张潍平,黄澄如,孙宁,等.尿道下裂手术方法选择.中华泌尿外科杂志,2001,22:301-303
[18]陈于明,邹大卫.尿道口前移-龟头成形术与尿道延伸术联合治疗尿道下裂.中华整形外科杂志,2005,20:28-30
[19]Minevich E,Pecha BR,Wacksman J,et al.Mathieu hypospadias repair:experience in 202 patients.J Urol,1999,162:2141-2143
[20]段光琦,潘永康,浦征宇,等.先天性尿道下裂68例手术体会.临床小儿外科杂志,2007,3:27-28
[21]田军,黄澄如,孙宁,等.加盖与管形包皮岛状皮瓣法在尿道下裂治疗中的应用.中华泌尿外科杂志,2005,26,847-849
[22]Elbakry A.Complications of the preputial island flap-tube urethroplasty.BJU Int,1999,84:89-94
[23]袁继炎,周学锋,杨晓进,等.保留尿道板外嵌带蒂岛状包皮瓣一期尿道成形术.中华小儿外科杂志,1997,18:372
[24]Snodgrass W.Tubularize dincised plate urethroplasty for distal hypospadias.J Urol,1994,151:464-465
[25]Snodgrass W,Koyle M,Manzoni G,et al.Tubularized incised plate hypospadias repair:results of amulticenter experience.J Urol,1996,156:839-841
[26]唐仕忠,范霞,易亮,等.60例小儿尿道下裂的临床诊治分析.亚太传统医药,2009,5:32-33
[27]王军,孙福涛,马玉坤,等.Snodgrass尿道成形术治疗先天性尿道下裂效果.齐鲁医学杂志,2009,24:157-158
[28]白东升,郝春尘,叶辉,等.Snodgrass法在尿道下裂治疗中的临床应用(附294例报告).北京医学,2008,44:667-669
[29]陈方,薛皓亮,徐卯升,等.尿道板纵切卷管尿道成形在尿道下裂中的应用.中华泌尿外科杂志,200l,22:395-397
[30]Oswald J,Komer I,Riccabona M,et al.Comparison of the Preimeatal based flap(Mathieu) and the tabularized incised plate urethroplasty(Snodgrass) in primary distal hypospadias.BJU Int,2000,85:725-727
[31]Nguyen MT.Snodgrass Tubularized incised plate hypospadias reoperation.J Urol,2004,171:2404-2406
[32]Preston.S.Acomprehensive anaalysis of a tubularized incised plate hypospadias repair.Urology,2001,57:778-782
[33]Soygur T,Arikan N,Zumrutbas AE,et al.Snodgrass hypospadias repair with ventral based dartos flap in combination with mucosal collars.Eur Urol,2005,47:879-884
[34]Cheng EY,Vemulapalli SN,Kropp BP,et al.Snodgrass hypospadias repair with vascularized dartos flap:the perfect repair for virgin cases of hypospadias? J Urol,2002,164:1723-1726
[35]Furness PD,Hutcheson J.Successful hypospadias repair with entral based vascular dartos pedicle for urethral coverage.J Urol,2003,169:1825-1827
[36]徐哲,谢家伦,刘文旭,等.前尿道板加游离包皮内板尿道成形术治疗尿道下裂.中华小儿外科杂志,2005,26:418-419
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[38]何大维,李旭良,魏光辉,等.尿道板在尿道下裂一期手术中的应用.中华泌尿外科杂志,2003,24:854
[39]袁继炎,周学锋,杨晓进,等.保留尿道板外嵌带蒂岛状包皮瓣一期尿道成形术.中华小儿外科杂志,1997,18:372
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[41]陈方,薛皓亮,徐卯升,等.尿道板纵切卷管尿道成形在尿道下裂中的应用.中华泌尿外科杂志,2001,22:395-397
[42]阮双岁,葛琳娟,陆毅群,等.尿道下裂不同术式的疗效评价.中华泌尿外科杂志,2001.22:364-366
[43]Hansson E,Becker M,Aberg M,et al.Analysis of complications alter repair of hypospadias.Scand J Plast Reconstr Surg Hand Surg,2007,41:1204
[44]Snodgrass WT.Tubularized incised plate hypospadias repair:indications,technique,and complications.Urology,1999,54:6-11
[45]Elder JS,Ducker JW,Snyder HM,et al.Onlay island flap in the repair of mid and distal penile lrypospadias without chordee.J Urol,1987,138:376-379
[46]Snodgrass WT,Lorenzo A.Tubularized,incised-plate urethroplasty for proximal hypospadias.BJU Internal,2002,89:90-93
[47]Borer JC,Bauer SB,Peters CA,et al.Tubularized,incised plate urethroplasty:expanded use in primary and repeat surgery for hypospadias.J Urol,2001,165:581-585
[1]Baskin LS.Hypospadias an durethral development.J Urol,2000,163,951-956
[2]吴艳乔,王艳萍,朱军,等.国人尿道下裂的流行病学特征.中华泌尿外科杂志,1997,18,753-757
[3]贺厚光.尿道下裂病因学研究进展.国外医学泌尿系统分册,2004,24,296-299
[4]黄澄如.主编,小儿泌尿外科学.第1版,济南:山东科学技术出版社,1996,180-202
[5]Hayashi Y,Kojima Y.Current concepts in hypospadias surgery.Int J Urol.2008,15:651-664
[6]Koevara R,Dvoracek J.In lay- onlay flap urethroplasty for hypospadias andure thrall structure repair.J Urol,1997,158:2142-2145
[7]Baskin LS.尿道下裂的病因及解剖学研究.中华小儿外科杂志,2000,21:62-63
[8]谢向辉,黄澄如,孙宁,等.保留尿道板手术在尿道下裂治疗中的应用.中华小儿外科杂志,2003,24:136-138
[9]何大维,李旭良,魏光辉,等.尿道板在尿道下裂一期手术中的应用.中华泌尿外科杂志,2003,24:854
[10]马代明,戴建东.Snodgrass尿道成形术治疗尿道下裂的体会.中国妇幼保健,2007,22:897-898
[11]张旭辉,王计文.Snodgrass尿道成形术在小儿尿道下裂中的应用.临床小儿外科杂志,2005,4:327-329
[12]阮双岁,葛琳娟,陆毅群,等.尿道下裂不同术式的疗效评价.中华泌尿外科杂志,2001,22:364-366
[13]Baskin S,AliErol,Ying WuLi,et al.Anatomical studies of hypospadias.J Urol,1998,160:1108-1115
[14]Duckett JW.MAGPI(meatoplasty and glanuloplasty):a procedure for subcoronal hypospadias.Urol Clin North Am,1981,8:513-519
[15]翟成琦,周德贵,赵成辉,等.尿道前移治疗尿道下裂.中华小儿外科杂志,1998.19:299
[16]孟凡全,公培云.改良式MAGPI氏法治疗前尿道狭窄.实用医技志,2007,14:768-769
[17]张潍平,黄澄如,孙宁,等.尿道下裂手术方法选择.中华泌尿外科杂志,2001,22:301-303
[18]陈于明,邹大卫.尿道口前移-龟头成形术与尿道延伸术联合治疗尿道下裂.中华整形外科杂志,2005,20:28-30
[19]Minevich E,Pecha BR,Wacksman J,et al.Mathieu hypospadias repair:experience in 202 patients.J Urol,1999,162:2141-2143
[20]段光琦,潘永康,浦征宇,等.先天性尿道下裂68例手术体会.临床小儿外科杂志,2007,3:27-28
[21]田军,黄澄如,孙宁,等.加盖与管形包皮岛状皮瓣法在尿道下裂治疗中的应用.中华泌尿外科杂志,2005,26,847-849
[22]Elbakry A.Complications of the preputial island flap-tube urethroplasty.BJU Int,1999,84:89-94
[23]袁继炎,周学锋,杨晓进,等.保留尿道板外嵌带蒂岛状包皮瓣一期尿道成形术.中华小儿外科杂志,1997,18:372
[24]Snodgrass W.Tubularize dincised plate urethroplasty for distal hypospadias.J Urol,1994,151:464-465
[25]Snodgrass W,Koyle M,Manzoni G,et al.Tubularized incised plate hypospadias repair:results of amulticenter experience.J Urol,1996,156:839-841
[26]唐仕忠,范霞,易亮,等.60例小儿尿道下裂的临床诊治分析.亚太传统医药,2009,5:32-33
[27]王军,孙福涛,马玉坤,等.Snodgrass尿道成形术治疗先天性尿道下裂效果.齐鲁医学杂志,2009,24:157-158
[28]白东升,郝春尘,叶辉,等.Snodgrass法在尿道下裂治疗中的临床应用(附294例报告).北京医学,2008,44:667-669
[29]陈方,薛皓亮,徐卯升,等.尿道板纵切卷管尿道成形在尿道下裂中的应用.中华泌尿外科杂志,200l,22:395-397
[30]Oswald J,Komer I,Riccabona M,et al.Comparison of the Preimeatal based flap(Mathieu) and the tabularized incised plate urethroplasty(Snodgrass) in primary distal hypospadias.BJU Int,2000,85:725-727
[31]Nguyen MT.Snodgrass Tubularized incised plate hypospadias reoperation.J Urol,2004,171:2404-2406
[32]Preston.S.Acomprehensive anaalysis of a tubularized incised plate hypospadias repair.Urology,2001,57:778-782
[33]Soygur T,Arikan N,Zumrutbas AE,et al.Snodgrass hypospadias repair with ventral based dartos flap in combination with mucosal collars.Eur Urol,2005,47:879-884
[34]Cheng EY,Vemulapalli SN,Kropp BP,et al.Snodgrass hypospadias repair with vascularized dartos flap:the perfect repair for virgin cases of hypospadias? J Urol,2002,164:1723-1726
[35]Furness PD,Hutcheson J.Successful hypospadias repair with entral based vascular dartos pedicle for urethral coverage.J Urol,2003,169:1825-1827
[36]徐哲,谢家伦,刘文旭,等.前尿道板加游离包皮内板尿道成形术治疗尿道下裂.中华小儿外科杂志,2005,26:418-419