多线法纵切尿道板成形术治疗尿道下裂

周振军

[摘要] 目的 探讨多线法纵切尿道板成形术（Multiple longitudinal lines incised plate urethroplasty，MLLIPU）治疗尿道下裂。 方法 方便选取2012年9月—2016年12月于该院收住的61例尿道下裂患者为研究对象。以阴茎头发育较好，能够形成新龟头为手术适应证，随机将患者分为两组，31例采用多线法纵切尿道板成形术（治疗组），30例采用单一正中纵切尿道板成形术（对照组），并因此分为两组。所有患者均为初次就诊病例，其中阴茎体型34例，阴茎阴囊型27例。观察手术及术后并发症情况。结果 对这些患者术后进行密切随访半年，治疗组均没有出现尿道狭窄和尿瘘并发症。同期单纯snodgrass法治疗的30例患者术后出现尿瘘2例，尿道狭窄4例。两组术后并发症差异有统计学意义（P<0.05）。 结论 MLLIPU法治疗尿道下裂获得了满意的治疗效果，手术方法容易，并发症发生率很低。

[关键词] 多线法；尿道板；成形术；尿道下裂

[中图分类号] R699 [文献标识码] A [文章编号] 1674-0742（2017）05（c）-0072-03

[Abstract] Objective To study the multiple longitudinal lines incised plate urethroplasty in treatment of hypospadias. Methods 61 cases of patients with hypospadias admitted and treated in our hospital from September 2012 to December 2016 were convenient selected and the divided into two groups， the treatment group with 31 cases were treated with multiple longitudinal lines incised plate urethroplasty， while the control group with 30 cases were treated with single longitudinal median urethral plate plasty， and all patients were the initial diagnosis cases including 34 cases with penile type and 27 cases with penile scrotal type， and the operation and postoperative complications were observed. Results The patients were closely followed up for half a year after operation， and there were no urethrostenosis and urinary fistula complications in the treatment group， and of 30 cases of patients treated by the simple Snodgrass method at the same period， there were 2 cases with urinary fistula and 4 cases with urethrostenosis（P<0.05）. Conclusion The effect of MLLIPU method in treatment of hypospadias is satisfactory and the operation method is simple with extremely low incidence rate of complications.

[Key words] Multiple-line method； Urethral plate； Plasty； Hypospadias

尿道下裂是一種常见的泌尿系统畸形。发病率约0.32%[1]。尿道板目前被越来越多的泌尿界专家作为首选组织进行尿道重建[2]。Snodgrass法保留尿道板手术治疗尿道下裂被广泛应用，该手术采用单一正中线纵切尿道板卷管治疗尿道下裂，但术后仍存在常见的并发症：5.4%～50.0%尿道狭窄率[3]，2%～47%的尿瘘发生率[4-6]。分析原因与尿道板上皮之间间距过大有关，致使上皮愈合时间长，更易并发感染、伤口瘢痕缩窄所致。同时也存在某些张力过大的因素，导致局部组织缺血、坏死，以至愈合不良、感染，导致了相应的并发症出现。该研究根据临床实际，采用多线法纵切尿道板成形术（MLLIPU）治疗尿道下裂。方便选取2012年9月—2016年12月于该院收住的61例尿道下裂患者为研究对象，开展该临床研究，现报道如下。……