Chao Min,Zhang Yin,Jiang Jiabin,et al.Application experiences of integral covering technique of Buck’s fascia plus glans wings during tubularized incised plate urethroplasty for restoring normal penile anatomy of hypospadias[J].Journal of Clinical Pediatric Surgery,2020,19(12):1088-1093,1112.[doi:10.3969/j.issn.1671-6353.2020.12.006]
BUCK筋膜联合阴茎头两翼整体覆盖恢复尿道下裂阴茎解剖结构在尿道板纵切尿道卷管成形术中的应用效果
- Title:
- Application experiences of integral covering technique of Buck’s fascia plus glans wings during tubularized incised plate urethroplasty for restoring normal penile anatomy of hypospadias
- 分类号:
- R726.9;R697+.11;R695
- 摘要:
- 目的 探讨应用Buck筋膜连同阴茎头两翼组织整体覆盖技术恢复阴茎体及阴茎头的解剖结构的方法在儿童尿道下裂尿道板纵切卷管尿道成形术（tubularized incised plate，TIP）中的实用性及疗效。方法 回顾性分析2018年1月至2020年8月安徽省儿童医院泌尿外科128例应用TIP手术一期修复的尿道下裂病例，根据术中成形尿道覆盖方法的不同分成A、B两组：A组为Buck筋膜整体覆盖TIP手术，即应用Buck筋膜连同阴茎头两翼组织整体覆盖技术以恢复阴茎解剖结构进行TIP手术（n=77）；B组采用传统肉筋膜交叉覆盖TIP手术，即采用包皮肉筋膜交叉覆盖的传统TIP手术（n=51）。记录两组围手术期临床资料以及术后随访资料，对结果进行统计学分析。结果 两组均顺利完成手术，A、B两组在平均年龄、尿道开口位置、平均阴茎体长度、平均阴茎头高度、平均阴茎头宽度、平均尿道板宽度、平均阴茎下弯度数、背侧海绵体折叠例数、平均成形尿道长度、平均手术时间等临床资料方面差异均无统计学意义（P>0.05）。术后随访3~32个月，A、B两组发生并发症例数分别为9例（11.6%）和13例（25.4%），差异有统计学意义（χ2=4.10，P=0.04）；尿瘘分别为5例（6.5%）和9例（17.6%），差异有统计学意义（χ2=3.92，P=0.04）；冠状沟瘘分别为3例（3.9%）和7例（13.7%），差异有统计学意义（χ2=4.11，P=0.04）；而A、B两组尿道口狭窄分别为2例（2.6%）和1例（2%），尿道裂开分别为2例（2.6%）和3例（5.9%），差异无统计学意义（P>0.05）。结论 应用Buck筋膜联合阴茎头两翼组织整体覆盖技术改良的TIP手术修复儿童尿道下裂是安全、实用、有效的。该术式可以尽可能地恢复阴茎体解剖结构并降低TIP手术后尿瘘特别是冠状沟瘘的发生率。
- Abstract:
- Objective To explore the practicability and efficacy of integral coverage technique of Buck’s fascia plus glans wings for restoring anatomical penile structure during tubularized incised plate (TIP) urethroplasty for children with hypospadias.Methods From January 2018 to August 2020,128 cases of primary hypospadias underwent TIP urethroplasty were retrospectively analyzed.They were divided into two groups of A (n=77) and B (n=51) according to different covering methods.Group A underwent modified one-stage TIP urethroplasty with a new coverage technique of Buck’s fascia plus glans wings for restoring anatomical structure of penis.And group B underwent a conventional TIP procedure with a covering of superficial (dartos) fascia of foreskin.The perioperative clinical data and postoperative follow-up data of two groups were recorded and the results statistically analyzed.Results All operations were successful.No inter-group statistically significant difference existed in equilibrium test,such as age,position of urethral opening,penile length,average height/width of penile head,average width of urethral plate,curvature degree,number of cases of dorsal plication,average length of urethroplasty or average operative duration (P>0.05).During an average period of 16.5(3-32) months,they were followed up by telephones,emails,face-to-face consultations and online tools.Significant inter-group differences existed in the total number of postoperative complications,incidence of urinary and coronal fistulas.The postoperative complications of groups A and B were (n=9,11.6%) and (n=13,25.4%) respectively, there was significant inter-group difference (P=0.04).The urethral fistula of groups A and B were (n=5,6.5%) and (n=9,17.6%), including coronal fistulas (n=3,3.9%) and (n=7,13.7%) respectively, there was significant inter-group difference existed (P=0.04).In groups A and B,there were urethral stricture (n=2,2.6%)/(n=1,2%) and (n=2,2.6%)/(n=3,5.9%) of urethral dehiscence respectively.There was no significant inter-group difference (P>0.05).Conclusion Modified TIP procedure of integral coverage technique of Buck’s fascia plus glans wings is safe,practical and effective for repairing hypospadias in children.It can restore anatomic structure of penis and reduce the incidence of urinary fistula,especially coronal fistula.
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备注/Memo
收稿日期:2020-09-26。
基金项目:安徽省卫生健康委员会科研计划项目（编号：2019SEY006）；安徽省儿童医院院级课题（编号：2018112）；安徽省儿童医院重点专科项目（编号：20186212）
通讯作者:潮敏,Email:cm0654@sina.com