Shi Haoyu,Huang Liqu,Guo Yunfei.Research advances in related operative approaches of repairing proximal hypospadias with severed urethral plate tissue[J].Journal of Clinical Pediatric Surgery,2022,21(01):24-29.[doi:10.3760/cma.j.cn.101785-202008077-005]
利用横断后尿道板组织修复近段型尿道下裂的术式研究进展
- Title:
- Research advances in related operative approaches of repairing proximal hypospadias with severed urethral plate tissue
- Keywords:
- Hypospadias/SU; Reconstructive Surgical Procedures; Postoperative Complications; Treatment Outcome
- 摘要:
- 尿道下裂（hypospadias）是儿童泌尿生殖系统常见的先天畸形之一，发病率较高且有增加趋势，其中近段型尿道下裂占比逐年增加，严重影响患儿阴茎发育。近段型尿道下裂多合并严重阴茎下弯，手术治疗以横断尿道板术式为主，术后并发症发生率明显高于保留尿道板术式。目前，Duckett术式的应用最为广泛，但存在手术操作困难以及尿道狭窄、尿道憩室等并发症发生率较高等问题，影响治疗效果。近年来利用横断后尿道板组织的手术方式不断增多。本文对该类术式进行综述，以期为临床医生选择近段型尿道下裂术式提供参考。
- Abstract:
- Hypospadias is one of the most common congenital malformations in pediatric urogenital system with a high incidence rate.The rising proportion of proximal hypospadias has seriously affected pediatric patients’ penile development.Most proximal hypospadias cases are complicated with severe penile curvature and treated with transverse urethral plate resection.But such surgical procedure has a significantly higher incidence of postoperative complications than retaining urethral plate.Currently Duckett’s procedure is widely applied for proximal hypospadias.However, it is difficult to operate and faces common complications of urethral stricture and diverticulum.In recent years, more and more surgical approaches have been developed for preserving transverse urethral plate.This review discusses various operative approaches to provide clinicians with practical references for proximal hypospadias repair.
参考文献/References:
[1] 陈绍基.重型尿道下裂治疗策略[J].临床小儿外科杂志,2018,17(8):567-570.DOI:10.3969/j.issn.1671-6353.2018.08.003. Chen SJ.Therapeutic strategies of severe hypospadias[J].J Clin Ped Sur,2018,17(8):567-570.DOI:10.3969/j.issn.1671-6353.2018.08.003.
[2] 张源锋,吕军.尿道下裂外科治疗常用术式的现状和进展[J].中国男科学杂志,2009,23(10):63-66.DOI:10.3969/j.issn.1008-0848.2009.10.021. Zhang YF,Lü J.Current status and recent advances of common surgical approaches for hypospadias[J].Chin J Androl,2009,23(10):63-66.DOI:10.3969/j.issn.1008-0848.2009.10.021.
[3] Long CJ,Canning DA.Hypospadias:Are we as good as we think when we correct proximal hypospadias?[J].J Pediatr Urol,2016,12(4):196.e1-e5.DOI:10.1016/j.jpurol.2016.05.002.
[4] Duckett JW Jr.Successful hypospadias repair[J].Contemp Urol,1992,4(5):42-45.
[5] Giannantoni A.Hypospadias classification and repair:the riddle of the sphinx[J].Eur Urol,2011,60(6):1190-1191.DOI:10.1016/j.eururo.2011.08.057.
[6] Mavrogenis S,Czeizel AE.Trends in the prevalence of recorded isolated hypospadias in Hungarian newborn infants during the last 50 years-A population-based study[J].Reprod Toxicol,2013,42:251-255.DOI:10.1016/j.reprotox.2013.09.007.
[7] Pippi Salle JL,Sayed S,Salle A,et al.Proximal hypospadias:A persistent challenge.Single institution outcome analysis of three surgical techniques over a 10-year period[J].J Pediatr Urol,2016,12(1):28.e1-e7.DOI:10.1016/j.jpurol.2015.06.011.
[8] Castagnetti M,El-Ghoneimi A.Surgical management of primary severe hypospadias in children:systematic 20-year review[J].J Urol,2010,184(4):1469-1475.DOI:10.1016/j.juro.2010.06.044.
[9] Baskin LS,Erol A,Li YW,et al.Anatomical studies of hypospadias[J].J Urol,1998,160(3):1108-1115.DOI:10.1097/00005392-199809020-00039.
[10] Snodgrass W,Patterson K,Plaire JC,et al.Histology of the urethral plate:Implications for hypospadias repair[J].J Urol,2000,164(3 Pt 2):988-990.DOI:10.1097/00005392-200009020-00017.
[11] Acimi S,Acimi MA.Can We Preserve the Urethral Plate in Proximal Hypospadias Repair?[J].Ann Plast Surg,2017,79(1):68-72.DOI:10.1097/SAP.0000000000001055.
[12] Hayashi Y,Mizuno K,Kojima Y,et al.Characterization of the urethral plate and the underlying tissue defined by expression of collagen subtypes and microarchitecture in hypospadias[J].Int J Urol,2011,18(4):317-322.DOI:10.1111/j.1442-2042.2010.02713.x.
[13] 孙宁.尿道下裂修复手术问题与再认识[J].中华小儿外科杂志,2015,36(3):161-162.DOI:10.3760/cma.j.issn.0253-3006.2015.03.001. Sun N.Problems and recognition of hypospadias repair surgery[J].Chin J Pediatr Surg,2015,36(3):161-162.DOI:10.3760/cma.j.issn.0253-3006.2015.03.001.
[14] 鲍星奇,黄轶晨,谢华,等.尿道下裂尿道板周围尿道海绵体的组织形态学研究[J].中华小儿外科杂志,2019,40(11):1030-1035.DOI:10.3760/cma.j.issn.0253-3006.2019.11.015. Bao XQ,Huang YC,Xie H,et al.Histomorphological study of urethral cavernous body around urethral plate in hypospadias[J].Chin J Pediatr Surg,2019,40(11):1030-1035 DOI:10.3760/cma.j.issn.0253-3006.2019.11.015.
[15] 张潍平.尿道下裂手术治疗的热点与难点问题[J].临床小儿外科杂志,2016,15(5):417-419.DOI:10.3969/j.issn.1671-6353.2016.05.001. Zhang WP.Hot and difficult issues in surgical treatment of hypospadias[J].J Clin Ped Sur,2016,15(5):417-419.DOI:10.3969/j.issn.1671-6353.2016.05.001.
[16] 毛小波.尿道下裂合并阴茎下弯的病理学研究及手术治疗进展[J].临床小儿外科杂志,2013,12(2):153-155.DOI:10.3969/j.issn.1671-6353.2013.02.024. Mao XB.Progress in pathological study and surgical treatment of hypospadias with penile curvature[J].J Clin Ped Sur,2013,12(2):153-155.DOI:10.3969/j.issn.1671-6353.2013.02.024.
[17] Braga LH,Lorenzo AJ,B?gli DJ,et al.Ventral penile lengthening versus dorsal plication for severe ventral curvature in children with proximal hypospadias[J].J Urol,2008,180(4):1743-1748.DOI:10.1016/j.juro.2008.03.087.
[18] Abosena W,Talab SS,Hanna MK.Recurrent chordee in 59 adolescents and young adults following childhood hypospadias repair[J].J Pediatr Urol,2020,16(2):162.e1-e5.DOI:10.1016/j.jpurol.2019.11.013.
[19] 刘伟,吴荣德,张北叶,等.保留尿道板加包皮岛状皮瓣尿道成形术一期治疗尿道下裂的疗效观察[J].中华小儿外科杂志,2015,36(3):170-173.DOI:10.3760/cma.j.issn.0253-3006.2015.03.003. Liu W,Wu RD,Zhang BY,et al.Observation on the curative effect of urethroplasty with preputial island flap in the treatment of hypospadias[J].Chin J Pediatr Surg,2015,36(3):170-173.DOI:10.3760/cma.j.issn.0253-3006.2015.03.003.
[20] 黄立渠,郭云飞,马耿,等.Onlay-tube-Onlay术式一期治疗重度尿道下裂的临床应用[J].中华泌尿外科杂志,2016,39(2):122-126.DOI:10.3760/cma.j.issn.1000-6702.2016.02. Huang LQ,Guo YF,Ma G,et al.Clinical application of Onlay tube Onlay operation in the treatment of severe hypospadias[J].Chin J Urol,2016,39(2):122-126.DOI:10.3760/cma.j.issn.1000-6702.2016.02.
[21] Huang Y,Xie H,Lü Y,et al.One-stage repair of proximal hypospadias with severe chordee by in situ tubularization of the transverse preputial island flap[J].J Pediatr Urol,2017,13(3):296-299.DOI:10.1016/j.jpurol.2017.02.015.
[22] 陈志锋.保留尿道板治疗尿道下裂的临床效果分析[D].吉林大学,2018. Chen ZF.Clinical effect analysis of retaining urethral plate in the treatment of hypospadias[D].Jilin University,2018.
[23] 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[J].中华泌尿外科杂志,2005,26(12):847-849.DOI:10.3760/j:issn:1000-6702.2005.12.017. Tian J,Huang CR,Sun N,et al.Application of covering and tubular prepuce island flap in the treatment of hypospadias[J].Chin J Urol,2005,26(12):847-849.DOI:10.3760/j:issn:1000-6702.2005.12.017.
[24] 陈嘉波,杨体泉,王双全,等.加盖包皮岛状皮瓣尿道成形术的临床应用和单因素分析[J].中华实用儿科临床杂志,2014,29(2):151-153.DOI:10.3760/cma.j.issn.2095-428X.2014.02.018. Chen JB,Yang TQ,Wang SQ,et al.Clinical application and univariate analysis of prepuce island flap urethroplasty[J].Chin J Appl Clin Pediatr,2014,29(2):151-153.DOI:10.3760/cma.j.issn.2095-428X.2014.02.018.
[25] Hayashi Y,Kojima Y,Nakane A,et al.A strategy for repairing moderately severe hypospadias using Onlay urethroplasty versus Onlay-tube-Onlay urethroplasty[J].Urology,2003,61(5):1019-1022.DOI:10.1016/s0090-4295(03)00014-1.
[26] Flack CE,Walker RD.Onlay-tube-Onlay urethroplasty technique in primary perineal hypospadias surgery[J].J Urol,1995,154(2):837.DOI:10.1097/00005392-199508000-00138.
[27] 郑妍,赵琦.TIP与Onlay-tube-Onlay术治疗小儿尿道下裂的效果对比研究[J].国际泌尿系统杂志,2018,38(2):234-237.DOI:10.3760/cma.j.issn.1673-4416.2018.02.017. Zheng Y,Zhao Q.Comparative study of tip and Onlay tube Onlay in the treatment of hypospadias in children[J].Inter Nati J Urol,2018,38(2):234-237.DOI:10.3760/cma.j.issn.1673-4416.2018.02.017.
[28] Rigamonti W,Castagnetti M.Onlay on albuginea:modified Onlay preputial island flap urethroplasty for single-stage repair of primary severe hypospadias requiring urethral plate division[J].Urology,2011,77(6):1498-1502.DOI:10.1016/j.urology.2010.09.048.
[29] 王志勇,王伟,尧俊波.Duckett术式与改良Snodgrass尿道成形术在小儿尿道下裂治疗中的疗效及并发症对比综合分[J].当代医学,2018,24(18):94-96.DOI:10.3969/j.issn.1009-4393.2018.18.041. Wang ZY,Wang W,Yao JB.Comprehensive analysis of the efficacy and complications of Duckett urethroplasty and modified Snodgrass urethroplasty in the treatment of hypospadias in children[J].Current Physician,2018,24(18):94-96.DOI:10.3969/j.issn.1009-4393.2018.18.041.
[30] 王千.Duckeet+改良Koyanagi术式治疗重度尿道下裂[C].中华医学会第八次全国小儿外科学术会,2010. Wang Q.Ducketet+modified Koyanagi procedure for the treatment of severe hypospadias[C].the Eighth National Pediatric Surgery Association of Chinese Medical Association,2010.
[31] Fraumann SA,Stephany HA,Clayton DB,et al.Long-term follow-up of children who underwent severe hypospadias repair using an online survey with validated questionnaires[J].J Pediatr Urol,2014,10(3):446-450.DOI:10.1016/j.jpurol.2014.01.015.
[32] Perera M,Jones B,O’Brien M,et al.Long-term urethral function measured by uroflowmetry after hypospadias surgery:comparison with an age matched control[J].J Urol,2012,188(4):1457-1462.DOI:10.1016/j.juro.2012.04.105.
[33] Spinoit AF,Poelaert F,Groen LA,et al.Hypospadias repair at a tertiary care center:long-term followup is mandatory to determine the real complication rate[J].J Urol,2013,189(6):2276-2281.DOI:10.1016/j.juro.2012.12.100.
[34] Myers JB,Porten SP,McAninch JW.The outcomes of perineal urethrostomy with preservation of the dorsal urethral plate and urethral blood supply[J].Urology,2011,77(5):1223-1227.DOI:10.1016/j.urology.2010.10.041.
[35] 谢华,陈方,黄轶晨,等.包皮岛状皮瓣尿道板重建尿道成形术初步报告[J].中华小儿外科杂志,2014,35(5):370-373.DOI:10.3760/cma.j.issn.0253-3006.2014.05.012. Xie H,Chen F,Huang YC,et al.One-stage urethroplasty by tubularization of reconstructed urethral plate using preputial island flap in proximal hypospadias with severe chordee[J].Chin J Pediatr Surg,2014,35(5):370-373.DOI:10.3760/cma.j.issn.0253-3006.2014.05.012.
[36] 陈嘉波.保留尿道板尿道成形术的理论基础与影响因素[J].中华小儿外科杂志,2013,34(7):543-546.DOI:10.3760/cma.j.issn.0253-3006.2013.07.016. Chen JB.Theoretical basis and influencing factors of urethroplasty with retained urethral plate[J].Chin J Pediatr Surg,2013,34(7):543-546.DOI:10.3760/cma.j.issn.0253-3006.2013.07.016.
[37] 冯东川,朱孝宇,李圆,等.尿道板斜切延长纵切部分卷管加Onlay皮瓣尿道成形术[J].中华小儿外科杂志,2018,39(7):506-509.DOI:10.3760/cma.j.issn.0253-3006.2018.07.007. Feng DC,Zhu XY,Li Y,et al.Urethroplasty with transurethral plate and extended longitudinal incision and Onlay flap urethroplasty[J].Chin J Pediatr Surg,2018,39(7):506-509.DOI:10.3760/cma.j.issn.0253-3006.2018.07.007.
[38] 曾莉,黄一东,马学,等.单中心尿道下裂术后残余阴茎下弯十年总结[J].中华小儿外科杂志,2019,40(11):981-987.DOI:10.3760/cma.j.issn.0253-3006.2019.11.006. Zeng L,Huang YD,Ma X,et al.Residual penile curvature after single-center hypospadias surgery for 10 years[J].Chin J Pediatr Surg,2019,40(11):981-987.DOI:10.3760/cma.j.issn.0253-3006.2019.11.006.
相似文献/References:
[1]杨艳芳,陈国盈,李骥,等.Snodgrass尿道成型术治疗小儿尿道下裂98例[J].临床小儿外科杂志,2008,7(02):31.
[2]陈江谊,马少锋,曹志清,等.T-1型脱落细胞异体组织补片代尿道治疗小儿重度尿道下裂的临床观察[J].临床小儿外科杂志,2008,7(04):0.
[3]郑洪,谭朝华.喉罩下吸入麻醉加骶麻在小儿尿道下裂成形术中的应用[J].临床小儿外科杂志,2007,6(01):17.
[4]段光琦,潘永康,浦征宇,等.先天性尿道下裂68例手术体会[J].临床小儿外科杂志,2007,6(03):14.
[5]陈建兵 崔杰 邹继军 季易 陈海妮 沈卫民.穿支皮瓣修复儿童指趾末端缺损[J].临床小儿外科杂志,2011,10(03):207.
[J].Journal of Clinical Pediatric Surgery,2011,10(01):207.
[6]段光琦 毕允力 张敏 管肖浩. Koyanagi手术和改良手术治疗重型尿道下裂[J].临床小儿外科杂志,2011,10(05):389.
[J].Journal of Clinical Pediatric Surgery,2011,10(01):389.
[7]胡志成 刘风昌 王利民. Duckett术式治疗尿道下裂74例[J].临床小儿外科杂志,2012,11(01):32.
[8]钭金法.新生儿巨型脐膨出的治疗策略[J].临床小儿外科杂志,2020,19(04):292.[doi:10.3969/j.issn.1671-6353.2020.04.002]
Tou Jinfa.Treatment strategy for neonatal giant omphalocele[J].Journal of Clinical Pediatric Surgery,2020,19(01):292.[doi:10.3969/j.issn.1671-6353.2020.04.002]
[9]黄紫君,徐素婷,李莎,等.程序化包扎法、延期手术治疗巨型脐膨出的疗效分析[J].临床小儿外科杂志,2020,19(04):301.[doi:10.3969/j.issn.1671-6353.2020.04.004]
Huang Zijun,Xu Suting,Li Sha,et al.Efficacy of treating giant omphalocele by procedural dressing and delayed closure[J].Journal of Clinical Pediatric Surgery,2020,19(01):301.[doi:10.3969/j.issn.1671-6353.2020.04.004]
[10]曾甜,李新宁,黄晶晶,等.同种异体脱细胞真皮修补术治疗巨型脐膨出的疗效分析[J].临床小儿外科杂志,2020,19(04):306.[doi:10.3969/j.issn.1671-6353.2020.04.005]
Zeng Tian,Li Xinning,Huang Jingjing,et al.Efficacy of allogeneic acellular dermal mantrix in repairing giant omphalocele[J].Journal of Clinical Pediatric Surgery,2020,19(01):306.[doi:10.3969/j.issn.1671-6353.2020.04.005]
[11]陈绍基,王学军,唐耘熳.尿道下裂手术策略十二字方针[J].临床小儿外科杂志,2022,21(01):1.[doi:10.3760/cma.j.cn.101785-202110018-001]
Chen Shaoji,Wang Xuejun,Tang Yunman.Treatment strategies of hypospadias: a brief analysis of Twelve-Character Principles[J].Journal of Clinical Pediatric Surgery,2022,21(01):1.[doi:10.3760/cma.j.cn.101785-202110018-001]
[12]覃道锐,王学军,毛宇,等.阴茎头沟背侧局部减容术在尿道下裂保留尿道板修复手术中的应用[J].临床小儿外科杂志,2022,21(01):13.[doi:10.3760/cma.j.cn.101785-202110036-003]
Qin Daorui,Wang Xuejun,Mao Yu,et al.Application of limited volume reduction of dorsal navicular fossa during repairing hypospadias with a preservation of urethral plate[J].Journal of Clinical Pediatric Surgery,2022,21(01):13.[doi:10.3760/cma.j.cn.101785-202110036-003]
备注/Memo
收稿日期:2020-10-25。
基金项目:国家自然科学基金（82000643）；江苏省自然科学基金（BK20200152）
通讯作者:郭云飞,Email:guozhaooso@163.com