Shen Yiding,Zhu Linfeng,Wang Xiaohao,et al.Treatment of recurrent curvature after hypospadias repair[J].Journal of Clinical Pediatric Surgery,2021,20(02):177-180.[doi:10.12260/lcxewkzz.2021.02.013]
尿道下裂术后再发阴茎下弯的处理策略
- Title:
- Treatment of recurrent curvature after hypospadias repair
- 分类号:
- R726.9 R697+.11 R695
- 摘要:
- 目的 回顾性分析尿道下裂术后再发阴茎下弯的处理效果。方法 收集2010-2019年浙江大学医学院附属儿童医院收治的尿道下裂术后再发阴茎下弯36例患者作为研究对象，人工勃起试验后用量角器测量阴茎下弯角度，根据矫正策略处理阴茎下弯：彻底脱套，去除阴茎腹侧的瘢痕组织后若阴茎伸直，为A组（n=4）；若阴茎下弯<30°，给予白膜折叠术矫正下弯，为B组（n=5）；若阴茎下弯>30°，在冠状沟下阴茎干处离断尿道，将近端尿道沿海绵体表面剥离去除短尿道对阴茎下弯的影响，阴茎伸直者为C组（n=20）；若仍存在阴茎下弯则给予白膜折叠术，为D组（n=7）。A、B两组中同时给予尿道相关并发症的处理，并给予阴茎皮肤无张力覆盖；C、D两组中同时改为鼻插管全身麻醉后给予口腔唇黏膜代尿道术。结果 所有患者随访1~9.2年，平均5.8年，均无阴茎下弯发生。其中A、B两组中尿道相关并发症处理后均再无尿道皮肤瘘、尿道憩室及尿道裂开的发生。C、D两组中6例（22.2%，6/27）尿道狭窄，急诊给予尿道造瘘，造瘘3个月后关闭瘘口，之后无尿道狭窄；5例（18.5%，5/27）尿道皮肤瘘，均在术后6个月予尿道瘘修补术。结论 程序化治疗策略可以矫正尿道下裂术后再发阴茎下弯；回溯首次手术过程，发现忽视了阴茎腹侧的病理因素，特别是尿道牵拉因素，首次处理过于保守是尿道下裂术后再发阴茎下弯的主要原因。
- Abstract:
- Objective To retrospectively analyze the treatment outcomes of recurrent penile curvature after hypospadias repair.Methods From 2010 to 2019,36 children with recurrent penile flexion after hypospadias repair were treated.Angle of penile flexion was measured with a protractor after artificial erection test.Penile flexion was treated according to the correction strategy.Penile flexion was completely ungloved and penile flexion stretched after removing scar tissue on ventral penis.If penile underbend was <30°,white membrane folding was performed in group B(n=5).If > 30°,urethra was separated from penile trunk under coronal sulcus and urethra at the proximal end stripped along the surface of cavernous body to remove the influence of short urethra on penile downbends.If downbends persisted,white membrane folding was performed in group D(n=7).Treatment of urethro-related complications resulted in tension-free coverage of penile skin in groups A and B.In groups C and D,oral and labial mucosa urethroplasty was performed under general anesthesia with nasal intubation.Results During an average follow-up period of 5.8(1-9.2) years,there was no instance of urethral cutaneous fistula,urethral diverticulum or urethral deja.In groups C and D,6 cases (22.2%,6/27) had urethral stricture.Urethrostomy was performed in emergency.Fistula was closed at Month 3 after urethrostomy.In 5 cases (18.5%,5/27),urethral cutaneous fistula was repaired at Month 6 post-operation. Conclusion During previous operations,the pathological factors of ventral penis and urethral traction were neglected and initial treatment was too conservative.Programmed treatment strategy may correct recurrent penile flexion after hypospadias.
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备注/Memo
收稿日期:2020-01-30。
基金项目:浙江省基础公益研究项目（编号：LGF19H05002）
通讯作者:陈光杰,Email:dr.chenguangjie@zju.edu.cn