Snodgrass手术加转移周围组织覆盖尿道治疗尿道下裂的疗效评价
摘要
目的:对Snodgrass手术加转移周围组织覆盖新尿道治疗尿道下裂的手术疗效的评价。探讨用Snodgrass手术加转移周围组织覆盖新尿道治疗尿道下裂可提高手术成功率。方法:回顾我科从2002年1月至2009年2月尿道下裂成形术119例,分别采取4种方法成形尿道:(1)Snodgrass法:87例;(2)Duckett法:17例;(3)阴囊纵隔瓣法:12例;(4)口腔黏膜移植法:3例。按照纳入标准获得研究对象76例,按新尿道是否加转周围组织分A组(未加盖)、B(加盖)两组,采用病例对照方法在术前各项指标无统计学差异的基础上,分别比较两组术后尿瘘发生率、尿道外口纵向裂隙状发生率、手术成功率、尿道外口狭窄发生率这四项指标。结果:A组共32例,尿瘘17例(53.13%),无尿瘘15例(46.87%);尿道外口形态呈纵向裂隙状30例(93.75%),不规整2例(6.25%);尿道外口狭窄1例(3.12%),未发生狭窄31例(96.88%);手术成功15例(46.87%),失败17例(53.13%)。B组共44例,尿瘘3例(6.82%),未发生尿瘘41例(93.18%);尿道外口呈纵向裂隙状43例(97.73%),不规整1例(2.27%);尿道外口狭窄2例(4.55%),未发生狭窄42(95.45%);手术成功41例(93.18%),失败3例(6.82%)。结论:Snodgrass手术加转移周围组织覆盖新尿道治疗尿道下裂较单纯采用Snodgrass法手术成功率有明显提高,降低了术后尿瘘的发生率,值得推广。
Objective: To discuss curative effect of operation which was about Using Snodgrass procedures to form urethra and adopting transplantation of tunica vaginalis of testis or dartos coat of dorsum prepuce to cover the new urethra. To explore using Snodgrass procedures to form urethra and adopting transplantation of tunica vaginalis of testis or dartos coat of dorsum prepuce to cover the new urethra can improve the success rate of operation. Methods: Summarized 119 cases of hypospadias operation using Snodgrass procedures to form urethra and adopting transplantation of tunica vaginalis of testis or dartos coat of dorsum prepuce to cover the new urethra which we had done from Dec 2008 to Feb 2009 cases, which were used four methods forming urethra: such as Snodgrass, Duckett, Scrotal scan disc method Oral mucosa transplants. We included in the forming of urethra Snodgrass method 76 surgery patients. According to the new urethral whether turn around surrounding tissues, we divided all cases into two groups:Group A without surrounding tissues;Group B with surrounding Tissues. Using case-control method, on the base of he same statistical standards. Compare the two groups of urinary leak rate, incidence longitudinal fissure shape, surgical success, stricture rate in outside the urethra. Results: Group A total of 32 cases, 17 cases of urinary leak (53.13%), 15 cases without urinary leak (46.87%); 30 cases of incidence longitudinal fissure shape (93.75%), 2 cases not (6.25%); one case of stricture rate in outside the urethra cases (3.12%), 31 cases not(96.88%), Successful cases were 15 (46.87%), failure 17 (53.13%). Group B total of 44 cases, 3 cases of urinary leak in (6.82%), 41 cases not urinary leak (93.18%), 43 cases of incidence longitudinal fissure shape (97.73%),not1case (2.27%), 2 cases of stricture rate in outside the urethra (4.55%), 42 cases not(95.45%), Successful operation were 41 cases, (93.18%)3 cases were failure (6.82%). Conclusions: The operation success rate of using Snodgrass procedures to form urethra and adopting transplantation of tunica vaginalis of testis or dartos coat of dorsum prepuce to cover the new urethra was higher than only Using Snodgrass procedures. It was worth to spreading and applying.
Objective: To discuss curative effect of operation which was about Using Snodgrass procedures to form urethra and adopting transplantation of tunica vaginalis of testis or dartos coat of dorsum prepuce to cover the new urethra. To explore using Snodgrass procedures to form urethra and adopting transplantation of tunica vaginalis of testis or dartos coat of dorsum prepuce to cover the new urethra can improve the success rate of operation. Methods: Summarized 119 cases of hypospadias operation using Snodgrass procedures to form urethra and adopting transplantation of tunica vaginalis of testis or dartos coat of dorsum prepuce to cover the new urethra which we had done from Dec 2008 to Feb 2009 cases, which were used four methods forming urethra: such as Snodgrass, Duckett, Scrotal scan disc method Oral mucosa transplants. We included in the forming of urethra Snodgrass method 76 surgery patients. According to the new urethral whether turn around surrounding tissues, we divided all cases into two groups:Group A without surrounding tissues;Group B with surrounding Tissues. Using case-control method, on the base of he same statistical standards. Compare the two groups of urinary leak rate, incidence longitudinal fissure shape, surgical success, stricture rate in outside the urethra. Results: Group A total of 32 cases, 17 cases of urinary leak (53.13%), 15 cases without urinary leak (46.87%); 30 cases of incidence longitudinal fissure shape (93.75%), 2 cases not (6.25%); one case of stricture rate in outside the urethra cases (3.12%), 31 cases not(96.88%), Successful cases were 15 (46.87%), failure 17 (53.13%). Group B total of 44 cases, 3 cases of urinary leak in (6.82%), 41 cases not urinary leak (93.18%), 43 cases of incidence longitudinal fissure shape (97.73%),not1case (2.27%), 2 cases of stricture rate in outside the urethra (4.55%), 42 cases not(95.45%), Successful operation were 41 cases, (93.18%)3 cases were failure (6.82%). Conclusions: The operation success rate of using Snodgrass procedures to form urethra and adopting transplantation of tunica vaginalis of testis or dartos coat of dorsum prepuce to cover the new urethra was higher than only Using Snodgrass procedures. It was worth to spreading and applying.
引文
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[3] Uygur MC, Unal D, Tan MO. Factors affecting outcome of one-stage anterior hypospadias repair analysis of 422 cases. Pediatr Surg Int, 2002, 18: 142-146.
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[6]史丽萍,赵学强,周云. Snodgrass尿道成形术治疗尿道下裂25例分析.中国误诊志, 2006, 6(15): 3005.
[7] Snow Bw, Cartwright PC, Unger K. Tunica vaginalis blanket wrap to prevent urethrocutaneous fistula: and 8-year Experience. J Urol, 1995, 153: 472-473.
[8] Furness PD. Successful Hypospadias repair with ventral based vascular dartos pedicle for urethral coverage. Journal of urology, 2003, 169: 1825-1827.
[9] Hayashi Y, Kojima Y. Kurokawa S, et al. Scrotal dartos flap for the prevention of the urethrocntaneous fistula on hypospadias urethroplasty international. J Urol, 2005, 12: 280-283.
[10] Djordjevic m. Perovic m, Perovic s, Dorsal dartos flap for preventing fistula in the Snodgrass hypospadias repair. BJU Int, 2005, 95: 1303-1309.
[11]潘勇,郭树忠.尿道下裂的临床治疗方法和进展.中国美容医学, 2005, 14, (5): 639-643.
[12]黄澄如.尿道下裂治疗现状.中华小儿外科杂志, 1997,11(2): 118-123.
[13] Sondgrass W. Tubularized incised plate urethroplasty for distal hypospadias. J Urol, 1994, 151: 464-465.
[14] Erol A, Baskin LS, Liyw L, et al. Anatomical studies of the urethral plate: Why preservation of the urethral plate I important in hypospadias repair. BJU Int, 2000, 85: 728-734.
[15] Soygur T, Arikan N, Zumrutbas AE. Snodgrass hypospadias repair with ventral based dartos flap in combination with mucosal collars. Eur Urol, 2005, 47 (6): 879-884.
[16] Hayashi Y, K ojima Y, Mizuno K. Tubularized incised plate urethroplasty for proximal hypospadias. J Urol, 2002, 9(2): 88-90.
[17] Fisher GJ, Kang S, Varani J, et al. M echanism s of photoaging and chrono-logicalskin aging. Arch Dermatol, 2002, 138 (11): 1462-1470.
[18] Uliasz A, Spencer JM. Chemoprevention of skin cancer and photoaging. Clin Dermat ol, 2004, 22(3): 178-182.
[19]薛冬,张炜,何小舟.尿道纵切卷管尿道成形术治疗小儿尿道下裂.中华小儿外科杂志, 2004, 25 (5): 425.
[20]王禾,于磊,袁建林.尿道下裂保留尿道内板一期尿道成形术365例报告.中华泌尿外科杂志, 2005, 26 (1): 61.
[21] Ceylan K, Koseoglu B, Tan O, et al. Urethrocutaneous fistula: acase report. Int Urol Nephrol, 2006, 38(1): 163-165.
[22]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(7): 45.
[23] Hayashi Y, Kojima Y, MizunoK. Tubularized incised plate urethroplast for proximal hypospadias. Int J Urol, 2002, 9(2): 88-90.
[24] Snodgrass W, Koyle M, Manzoni G, et al. Tubularized incised platehy pospadias repair for proxi mal hypos padias. J Urol, 1998, 159(6): 2129-2131.
[25] Buenger J, Driller H. Ectoin: an effective natural substance to prevent UVA-in -duced premature photoaging. Skin Pharmacol Physiol, 2004, 17(5): 232-237.
[26] Ceylan K, Koseoglu B, Tan O, et al. Urethrocutaneous fistula: a case report. Int Urol Nephrol, 2006, 38(1): 163- 165.
[27] Baskin L, Erol A, Li Y, et al. Anatomical studies of hypos padias. Urol, 1998, 160 (3): 11082-1115.
[28]欧善际,梁培育,彭晓晖.斜形包皮岛状皮瓣尿道成形术治疗尿道下裂.中华男科学杂志, 2006, 12(4): 337-339.
[29] Retik AB, Bauer SB, Mandell J, et al. Management of severe hypospadias with a 2 stage repair. J Urol 1994, 152: 749-51.
[30] Samuel M, Capps S, Worth A. Proximal hypospadias. Comparative evaluation of staged urethroplasty (modified Thiersch Duplay followed by Mathieu) and single stage on-lay island flap repair. Eur Urol, 2001, 40: 463-468.
[31] Cheng EY, Kropp BP, Pope JC, et al. Proximal division of the urethral plate in staged hypospadias repair. J Urol, 2003,170(4): 1580.
[32]贺厚光,张炜,吴天麟.苯甲酸雌二醇诱导小鼠尿道下裂动物模型的建立.中华男科学杂志, 2007, 13(1): 327.
[33] Snodgrass W, Koyle M, Manzoni G, et al. Tubularized incised plate hypospadis repair for proximal hypospadias. J Urol, 1998, 159(21): 29-31.
[34] Perlmutter AD, Montgomery BT, Steinhardt GF. Tunica vaginalis free graft for the correction of chordee. J Urol, 1985, 134(3): 11-30.
[35] Koff SA, Eakins M. The treatment of penile chordee using corporeal rotation. J Urol, 1984, 131: 931-941.
[36] Kaplan GW, Brock WA. The etiology of chordee. Urol Clin North Am. 1981, 18(8):383-385.
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