前尿道延伸术对保留尿道板的后型尿道下裂TIP手术效果的影响

目的 评估后型尿道下裂患者在进行保留尿道板的尿道修复TIP手术时，做前尿道延伸与否对手术效果的影响。方法 回顾分析笔者医院2012年6月~2016年6月间后型尿道下裂行保留尿道板TIP手术患者的临床资料，比较前尿道延伸对手术效果的影响。统计参数包括患者年龄、尿道开口位置、合并畸形、新建尿道长度、尿道板宽度、术后随访日期、术后并发症。结果 共统计57例患者，32例行TIP手术（1组），25例行前尿道延伸+TIP手术（2组），两组患者平均随访时间、就诊年龄、尿道缺损长度、尿道板宽度之间比较，差异无统计学意义（P>0.05）；手术时间1组158.4min与2组214.6min比较，差异有统计学意义（P<0.01）。2组明显长于1组；术后总的并发症发生率1组47%（15/32）与2组48%（12/25）比较，差异无统计学意义（P=0.933），其中尿瘘、尿道口后移、尿道口裂开发生率差异无统计学意义（P>0.05），2组发生3例尿道狭窄，均有典型的临床症状，1组没有尿道狭窄发生，差异有统计学意义（P=0.044）。结论 前尿道延伸由于尿道板的部分去血管化容易引起成形尿道的狭窄，该类狭窄多有典型的临床症状，需再次或多次手术修复，因此对于后型尿道下裂的患者不建议行前尿道延伸术。

Comparative Outcomes of Tubularized Incised Plate Urethroplasty (TIP) With and Without Urethral Plate (UP) Elevation in Primary Proximal Hypospadias Repair

Objective To compare outcomes of tubularized incised plate urethroplasty (TIP) with and without urethral plate(UP) elevation in primary proximal hypospadias repair. Methods Information on consecutive patients with proximal TIP repair with and without UP elevation and urethral mobilization by a single surgeon was reviewed between June 2012 and June 2016. The statistical parameters were compared according to the surgical technique, including the patient''s age, urethral opening position, associated anomaly, length of neourethral to be created, width of urethral plate, postoperative follow-up time and the postoperative complications. Results There were 57 proximal TIP patients with follow up, 25 with (group 2) and 32 without (group 1) UP elevation and urethral mobilization. There was no statistically significant difference between two groups about the length of neourethral to be created and width of urethral plate. The mean operation time was 158.4 (range, 105-220) minutes in the group 1 and 214.6 (range, 105-335) minutes in the group 2 (P<0.01).The overall complication rates were 47% (15/32) and 48% (12/25) in the group 1 and group 2 respectively (P=0.933). Urethrocutaneous fistula/meatal retrusion/neourethral stricture rates were 16% (5/32), 19% (6/32), 13% (4/32) in the group 1 compared to 16% (4/25)/, 12% (4/25),8% (4/25)in the group 2 (P=0.969,0.488,0.583) respectively. Patients with strictures developing in 0 and 3 (12%) in the group 1 and group 2 respectively(P=0.044). All structures were symptomatic (UTI, urinary retention) and another one or two stage operation was needed to rectify these strictures. Conclusion UP elevation and urethral mobilization with TIP resulted in focal devascularization of the neourethra with symptomatic stricture development. So we don''t recommend UP elevation and urethral mobilization with proximal TIP repair.