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摘要: 目的 探讨游离包皮内板尿道板头段镶嵌-尿道板纵切卷管尿道成形术(glans grafted tubularised incised plate，GG-TIP)治疗尿道下裂的临床可行性及应用效果。方法 收集分析2019年1月—2021年10月我院166例应用尿道板纵切卷管尿道成形术(TIP)手术修复尿道下裂的患儿资料。分为A、B 2组，其中A组为GG-TIP手术组，即在TIP手术中阴茎头段背侧加深纵切联合头段局部游离包皮内板镶嵌，B组为经典TIP手术组。记录A、B组临床随访资料、术后并发症情况、最大尿流率(Qmax)及尿道下裂客观评分标准(HOSE)，对结果进行统计学分析。结果 共166例纳入分析，患儿平均年龄(21.20±9.64)个月，随访时间6~34个月。阴茎头型14例，阴茎体型127例，阴茎阴囊型25例，阴囊型及会阴型0例。A组的手术时间长于B组，差异有统计学意义(P < 0.001)。A、B组术后总并发症情况差异无统计学意义(10.34% vs 15.74%，P=0.337)；尿道瘘(χ2=0.114，P=0.735)、尿道狭窄(χ2=0.365，P=0.546)及阴茎头裂开(χ2=0.506，P=0.477)的发生情况差异无统计学意义。A组术后2周的Qmax优于B组[(9.46±1.57) mL/s vs(8.12±1.18) mL/s]，差异有统计学意义(P < 0.001)。A组HOSE评分(15.09±0.98)分，且尿道口均位于阴茎头前端，呈垂直裂隙状，B组HOSE评分(14.67±0.85)分，A组HOSE评分高于B组，差异有统计学意义(P < 0.05)。结论 GG-TIP手术修复儿童尿道下裂是安全、有效的，该术式操作简单，可改善术后尿流率，且阴茎外观美观，值得推广。
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关键词:
- 尿道下裂 /
- 游离包皮内板 /
- 尿道板纵切卷管尿道成形术
Abstract: Objective To investigate the clinical feasiblility and application of glans grafted by free preputial plate-tubularized incised plate urethroplasty in hypospadias repair.Methods From January 2019 to October 2021, 166 cases of hypospadias repaired by TIP surgery in our hospital were collected and analyzed, and they were divided into two groups. Group A, that is, during TIP surgery, the dorsal deeper incision of the glans combined with local grafted free prepuce was performed, and group B, the classical TIP surgery was performed. Clinical follow-up data, postoperative complications, maximum urine flow rate (Qmax) and hypospadias objective scoring evalution (HOSE) score of group A and group B were recorded and analyzed.Results All 166 cases were included in the analysis. The follow-up time was 6-34 months, with an average age of (21.20±9.64) months. There were 14 cases of penile head type, 127 cases of penile body type, 25 cases of penile scrotal type, and 0 cases of scrotal and perineal type. Group A takes longer time than group B (P < 0.001), and the difference was statistically significant. There was no significant difference in total postoperative complications between group A and group B (10.34% vs 15.74%, P=0.337), as the same of the incidence of urethral fistula (χ2=0.114, P=0.735), urethral stricture (χ2=0.365, P=0.546) and glans separation (χ2=0.506, P=0.477). Qmaxat 2 weeks after operation in group A was better than that in group B ([9.46±1.57] mL/s vs[8.12±1.18] mL/s), and the difference was statistically significant (P < 0.001). HOSE score of group A was (15.09±0.98), and all the neomeatuses were at the tip of the glans and appreared vertical fissure. The score of group B was (14.67±0.85). The HOSE of score group A was higher than that of group B statistically (P < 0.05).Conclusion GG-TIP surgery is safe and effective for the repair of hypospadias in children. The surgery is simple, and the urine flow rate can be improved. Better cosmetic results can be achieved. Thus, it is worth popularizing. -
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表 1 2组患儿术后并发症情况比较
例(%) 组别 例数 尿道瘘 尿道狭窄 阴茎头裂开 并发症总数 A组 58 3(5.17) 2(3.45) 1(1.72) 6(10.34) B组 108 7(6.48) 6(5.56) 4(3.70) 17(15.74) χ2值 - 0.114 0.365 0.506 0.921 P值 - 0.735 0.546 0.477 0.337 
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表 2 2组患儿术后Qmax及HOSE评分比较
X±S 组别 例数 Qmax/(mL·s-1) HOSE评分/分 A组 58 9.46±1.57 15.09±0.98 B组 108 8.12±1.18 14.67±0.85 t值 - 6.184 2.866 P值 - < 0.001 0.005
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