Clinical application of allogeneic human acellular dermal matrix in penile corporal and urethral reconstruction surgery
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摘要: 目的 探讨异体人脱细胞真皮基质(human acellular dermal matrix，HADM)在阴茎体型尿道下裂手术中的治疗效果。方法 回顾性分析2019年1月—2022年12月在福建中医药大学附属漳州市中医院和厦门大学附属第一医院收治的58例初治阴茎体型尿道下裂患儿的临床资料，其中30例采用尿道板纵切卷管成形尿道术(tubularized incised-plate urethroplasty，TIP)治疗，28例采用TIP+异体HADM覆盖术治疗，比较2种手术的治疗效果。结果 采用TIP术后出现尿道外口轻度回缩6例，需再次手术的尿道皮肤瘘8例，尿道狭窄0例；采用TIP+异体HADM覆盖术术后出现尿道外口轻度回缩6例，需再次手术的尿道皮肤瘘2例，尿道狭窄0例。2种术式需再次手术的尿道皮肤瘘发生率比较差异有统计学意义(P < 0.05)，尿道外口轻度回缩发生率、尿道狭窄发生率比较差异无统计学意义(P>0.05)。结论 异体HADM作为新成型尿道的“保护层”可有效减少阴茎体型尿道下裂手术中尿瘘发生率。
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关键词:
- 尿道下裂 /
- 异体人脱细胞真皮基质 /
- 尿道板纵切卷管成形尿道 /
- 尿道皮肤瘘
Abstract: Objective To explore the therapeutic effect of allogeneic human acellular dermal matrix(HADM) in penile corporal and urethral reconstruction surgery for patients with penile hypospadias.Methods We compared the surgical outcomes between 30 cases treated with tubularized incised-plate urethroplasty(TIP) and 28 cases treated with TIP combined with HADM coverage from January 2019 to December 2022 in Zhangzhou Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine and The First Affiliated Hospital of Xiamen University.Results In the TIP group, there were 6 cases of mild retraction of the external urethral orifice and 8 cases of urethral cutaneous fistula requiring reoperation, with no cases of urethral stricture. In the TIP+HADM group, there were 6 cases of mild retraction of the external urethral orifice and 2 cases of urethral cutaneous fistula requiring reoperation, with no cases of urethral stricture. The incidence of urethral cutaneous fistula requiring reoperation showed a statistically significant difference between the two surgical methods (P < 0.05), while the rates of mild retraction of the external urethral orifice or urethral stricture showed no statistically significant difference(P>0.05).Conclusion Allogeneic HADM as a "protective layer" for neourethra can effectively reduce the incidence of urethral fistula in penile corporal and urethral reconstruction surgery for patients with penile hypospadias. -
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表 1 2组患儿一般情况比较
X±S 组别 年龄/月 阴茎下弯角度/° 尿道缺损长度/cm 随访时间/月 A组 25±13 18.6±9.5 1.9±0.6 5.8±3.5 B组 23±9 17.8±8.1 1.8±0.5 5.6±3.1 t 2.086 1.376 1.526 1.275 P值 0.093 0.285 0.225 0.334 
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