Fang Yiwei,Song Hongcheng,Sun Ning,et al.Application of tubularized incised urethral plate urethroplasty for hypospadias and its long-term follow-ups[J].Journal of Clinical Pediatric Surgery,2020,19(12):1082-1087.[doi:10.3969/j.issn.1671-6353.2020.12.005]
尿道板纵切卷管尿道成形术在尿道下裂中的应用及远期疗效
- Title:
- Application of tubularized incised urethral plate urethroplasty for hypospadias and its long-term follow-ups
- 分类号:
- R726.9;R697+.11;R695
- 摘要:
- 目的 回顾性分析行尿道板纵切卷管尿道成形术（tubularized incised urethral plate urethroplasty，TIP）治疗的尿道下裂患者阴茎的特点并对其进行远期随访，总结TIP手术的适应证，了解其远期排尿、性功能及社会心理状况，以提高对TIP手术的认识。方法 回顾性分析2004年1月至2011年12月初次行尿道下裂手术或尿道下裂术后再手术采用TIP手术治疗患者的临床资料，利用预先设计好的TIP手术后基本情况调查表通过电话随访及门诊复查，了解TIP手术远期疗效。结果 共266例尿道下裂患者纳入本研究（占同期行尿道成形术2 993例的8.89%），行TIP手术时年龄1岁至16岁9个月，平均5岁7个月。阴茎条件：术前无明显阴茎下弯74例，轻度阴茎下弯仅需包皮脱套及松解腹侧纤维组织矫正阴茎下弯106例，中度阴茎下弯需加做背侧白膜紧缩矫正阴茎下弯86例，无重度阴茎下弯；尿道板宽0.6~1.0 cm，均血供丰富、弹性好，纵切后宽1.0~1.4 cm。随访113例，随访率42.5%，失访153例。平均随访时间12.5年，末次随访时患者平均年龄为17岁10个月。83.2%的患者对阴茎外观满意，20.3%的患者存在排尿方面的问题，6.2%的患者存在阴茎下弯，所有患者均不存在阴茎勃起功能障碍、勃起疼痛等情况，98.2%的患者社会心理适应良好。结论 TIP手术的应用需严格把握其适应证，阴茎下弯不严重的远端型和中间型尿道下裂，且尿道板发育良好为TIP手术的严格适应证。在正确把握其适应证的基础上，患者远期可获得较好的阴茎外观、排尿及性功能。
- Abstract:
- Objective To review retrospectively the penile characteristics of hypospadias in children after tubularized incised plate (TIP) urethroplasty and summarize the indications of TIP so as to understand its long-term urination,sexual function and psychosocial status.Methods Clinical data were reviewed for 266 children undergoing initial and repeated TIP for hypospadias from January 2004 to December 2011.A pre-designed questionnaire of basic profiles after TIP was utilized along with a HOSE scoring system for examining long-term postoperative efficacy through telephone follow-ups and out-patient reviews.Results Among 2993 children undergoing urethroplasty during the same period,a total of 266 children (8.89%) fulfilled the inclusion criteria.The average operative age of TIP was 67(12-201) months.The conditions of penis were no obvious preoperative penile curvature (n=74),mild penile curvature corrected by foreskin degloving and released of ventral fibrous tissue (n=106) and moderate penile penile curvature corrected by dorsal placation (n=86).The width of urethral plate was approximately 0.6-1.0 cm with rich blood supply and excellent elasticity.And the width was around 1.0-1.4 cm after longitudinal incision.Follow-ups were conducted for 113 cases (42.5%) and 153 cases became lost to follow-ups.The mean follow-up period was 12.5 years and the mean age at the last follow-up 214 months.And they were satisfactory penile appearance (83.2%),urination dysfunctions (20.3%) and recurrent ventral curvature (6.2%).None of them had penile erectile dysfunction or painful erection and 98.2% achieved excellent psychosocial adjustments.Conclusion The strict indications of TIP should be grasped for distal and intermediate types of hypospadias with no severe penile curvature and decent development of urethral plate.Based upon correctly grasping the indications,children may obtain better long-term outcomes of appearance,urination and sexual function.
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备注/Memo
收稿日期:2020-07-16。
基金项目:国家重点研发计划（编号：2016YFC1000807）
通讯作者:宋宏程,Email:songhch1975@126.com