三种保留尿道板手术在轻中型尿道下裂矫治中的应用

目的探讨 TIP 手术、TIP 加游离包皮内板镶嵌式移植（inlay）手术和横行带蒂岛状包皮瓣加盖式尿道成形（onlay）三种手术在轻中型尿道下裂中的应用价值。方法2013年1月至2014年3月本中心收治104例可保留尿道板尿道下裂病例，其中70例采取 tip 术、19例采取 inlay 术和15例 on-lay 手术，回顾性分析三种术式治疗情况。结果本组104例，年龄14个月至21岁，平均42个月，术后随访（18～31）个月，平均22个月。TIP 组70例，成形尿道0.7～3 cm，平均1.53 cm，术后阴茎头裂开3例（4.3％），尿道皮肤瘘5例（7.1％），尿道狭窄2例（2.9％，经尿道扩张2～3次缓解）。Inlay 组19例，成形尿道0.8～2.3cm，平均1.37 cm，术后尿道皮肤瘘1例（5.3％）。Onlay 组15例，成形尿道2.0～3.2 cm，平均2.45 cm，术后阴茎头裂开1例（6.7％），尿道皮肤瘘1例（6.7％）。结论对于可保留尿道板的轻中型尿道下裂病例，根据尿道板特点采用 TIP、inlay 或 onlay 手术，可得到较好的矫治效果。

Application of three plate -preserving techniques in the treatment of penile hypospadias

Objetive To explore the application of tubularized incised plate (TIP),inlay and onlay urethroplasty for repairing hypospadias. Methods Retrospective analyses were conducted for the clinical data of patients with hypospadias repaired with TIP,inlay or onlay from January 201 3 to March. Results A con-secutive cohort of 1 04 patients were recruited.The average age was 42 (1 4 ~252)months.And the average follow-up period was 22 (1 8 ~31 )months.Seventy patients underwent TIP procedures.The average length of urethroplasty was 1 .53 (0.7 ~3.0)cm.There were glans dehiscence (n =3,4.3%),urethrocutaneous fis-tula (n =5,7.1 %)and urethral stricture (n =2,2.9%).Nineteen patients underwent inlay.The average length of urethroplasty was 1 .37 (0.8 ~2.3)cm.There was urethrocutaneous fistula(n =1 ,5.3%).Fifteen patients underwent onlaying.The average length of urethroplasty was 2.45 (2.0 ~3.2)cm.There were glans dehiscence (n =1 ,6.7%)and urethrocutaneous fistula(n =1 ,6.7%). Conclusions For hypospadias with preserved urethral plate,TIP,inlaying or onlaying may be selected according to plate features.Excellent out-comes are obtained.