本文選題：尿道下裂 + Duckett尿道成形術(shù)�。� 參考：《廣西醫(yī)科大學》2015年碩士論文

【摘要】：目的：通過比較分期橫裁包皮內(nèi)板帶蒂島狀皮瓣尿道成形術(shù)(Duckett)與一期Duckett手術(shù)治療尿道下裂的臨床療效,總結(jié)分期與一期Duckett手術(shù)適應(yīng)癥及并發(fā)癥的臨床規(guī)律。方法：回顧性分析廣西醫(yī)科大學第一附屬醫(yī)院小兒外科在2012年10月至2014年12月治療的尿道下裂患者162例,其中一期Duckett手術(shù)130例,年齡2歲-15歲,平均年齡(5.31±2.35)歲。分期Duckett手術(shù)32例,年齡2歲～13歲,平均年齡(4.59±2.58)歲。比較兩組病例陰莖局部解剖條件,如陰莖頭直徑、尿道板發(fā)育情況、陰莖陰囊轉(zhuǎn)位、陰莖彎曲程度、陰莖伸直后尿道外口位置、尿道缺損長度等指標。同時比較兩組手術(shù)的臨床效果,如尿瘺、尿道狹窄、尿道憩室、殘存陰莖下曲、尿道崩裂等術(shù)后常見并發(fā)癥的發(fā)生率和手術(shù)成功率。結(jié)果：一期Duckett手術(shù)130例中94例成功,手術(shù)成功率72.3%;分期Duckett手術(shù)32例中29例成功,手術(shù)成功率90.6%,分期Duckett手術(shù)組成功率明顯高于一期Duckett手術(shù),差異有統(tǒng)計學意義(X2=4.714,P=0.0300.05)。一期Duckett手術(shù)130例中36例出現(xiàn)術(shù)后并發(fā)癥,并發(fā)癥發(fā)生率27.7%,分期Duckett手術(shù)32例中3例出現(xiàn)術(shù)后并發(fā)癥,并發(fā)癥發(fā)生率9.4%,分期Duckett術(shù)后尿瘺、尿道狹窄及尿道憩室等主要并發(fā)癥發(fā)生率低于一期Duckett手術(shù),差異有統(tǒng)計學意義(P=0.0300.05)。一期Duckett手術(shù)組陰莖頭直徑≤1.2cm 43例,占33.1%(43/130例),分期Duckett手術(shù)組陰莖頭直徑≤1.2cm 25例(25/32例),占78.1%。分期Duckett手術(shù)組中陰莖頭直徑≤1.2CM的病例比一期Duckett手術(shù)組多(X2=21.396,P=0.0000.05),差異有統(tǒng)計學意義。一期Duckett手術(shù)組陰莖伸直后尿道外口位于陰莖陰囊交界處及陰囊29例,占22.3%(29/130例),分期Duckett手術(shù)組陰莖伸直后尿道外口位于陰莖陰囊交界處及陰囊25例,占78.1%(25/32例)。分期Duckett手術(shù)組陰莖伸直后尿道外口位于陰莖陰囊交界處及陰囊的比率比一期Duckett手術(shù)組高(X2=36.002,P=0.0000.05)。一期Duckett手術(shù)組尿道缺損長度(3.24±0.89cm),分期Duckett手術(shù)組尿道缺損長度(3.90±0.66cm),分期Duckett手術(shù)組尿道缺損長度大于一期Duckett手術(shù)組(t=2.930,P=0.0060.05),差異有統(tǒng)計學意義。一期Duckett手術(shù)組中陰莖彎曲程度呈中度96例,占73.8%(96/130例),呈重度34例,占26.2%(34/130例)。分期Duckett手術(shù)組陰莖彎曲程度呈中度5例,占15.6%(5/32例),呈重度27例,占84.4%(27/32例)。分期Duckett手術(shù)組中陰莖彎曲程度呈重度的病例比率比一期Duckett手術(shù)組高(X2=37.078,P=0.0000.05),差異有統(tǒng)計學意義。一期Duckett手術(shù)組尿道板發(fā)育差(≤0.4cm)106例,占81.5%(106/130例),分期Duckett手術(shù)組尿道板發(fā)育差(≤0.4cm)30例,占93.8%(30例/32例)。兩組病例中尿道板發(fā)育情況的差異無統(tǒng)計學意義(X2=2.842,P=0.0920.05)。一期手術(shù)組合并陰莖陰囊轉(zhuǎn)位22例,占16.9%(22/130例),分期手術(shù)組合并陰莖陰囊部分或完全轉(zhuǎn)位6例,占18.8%(6/32例)。兩組病例中陰莖陰囊轉(zhuǎn)位的差異無統(tǒng)計學意義(X2=0.060,P=0.8070.05)。結(jié)論：尿道下裂的矯治策略必須在綜合評估陰莖頭大小、尿道板發(fā)育情況、陰莖陰囊轉(zhuǎn)位、陰莖彎曲程度、陰莖伸直后尿道外口位置以及尿道缺損長度之后才能作出合理的決定。分期Duckett手術(shù)適應(yīng)癥如下：1.陰莖頭窄小(直徑≤1.2CM),陰莖發(fā)育不良,一期手術(shù)無法達到尿道正位開口者；2,尿道板纖維瘢痕攣縮導致陰莖重度下曲,需切斷尿道板才能充分伸直,同時造成尿道長段缺損者；3.局部皮膚材料不足或發(fā)育欠佳,難以一期尿道成形及修復陰莖外觀者；4.術(shù)者因技術(shù)水平不熟練或手術(shù)經(jīng)驗不足無法完成一期Duckett手術(shù)修復。正確選擇手術(shù)方式將明顯降低尿瘺或尿道狹窄等術(shù)后并發(fā)癥的發(fā)生率,從而提高手術(shù)成功率。
[Abstract]:Objective : To compare the clinical effects of stage and primary Duckett ' s operation on hypospadia in 162 patients with hypospadia treated with Duckett ' s operation from October 2012 to December 2014 . The results showed that the operative success rate was 72.3 % in the first stage of Duckett ' s operation , and the operative success rate was 90.6 % . The incidence of complications and complications occurred in 36 of the 130 cases of Duckett ' s operation in the first stage . The incidence of complications was 27 . 7 % . The complication rate was 9 . 4 % . The diameter of the posterior urethra of Duckett ' s operation group was less than or equal to 1.2 cm ( 25 / 32 ) . The length of urethra defect ( 3.24 鹵 0.89 cm ) and length of urethra defect ( 3.90 鹵 0.66 cm ) in stage I Duckett operation group were higher than that of primary Duckett operation group ( t = 2.930 , P = 0.0060.05 ) . There were 22 cases , 16.9 % ( 22 / 130 cases ) in the first - stage operation combined with the penis scrotum , and 6 cases ( 18.8 % ) were divided into two groups ( X2 = 0.060 , P = 0.8070.05 ) . Conclusion : It is necessary to comprehensively evaluate the size of the penis , the development of urethral plate , transposition of penis scrotum , the degree of penile curvature , the position of the posterior urethra and the length of the urethra defect . The indications of the stage Duckett operation are as follows : 1 . The diameter of the penis is narrow ( diameter 鈮，

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