3种尿道下裂尿道成形术251例分析

目的:总结Snodgrass、Duckett、膀胱粘膜尿道成形3种常用术式治疗中、后段尿道下裂的经验和体会,为临床术式选择提供参考。方法:对1997年至2008年间251例施行Snodgrass、Duckett、膀胱粘膜成形3种术式的中、后段尿道下裂进行回顾性分析。结果:3种术式在中段尿道下裂中成功率分别为80.3%(53/66)、76.0%(19/25)和78.9%(15/19),无明显统计学差异(P均>0.05);后段尿道下裂分别为70.0%(42/60)、63.6%(14/22)和88.1%(52/59),膀胱粘膜尿道成形在后段尿道下裂修补的成功率明显高于Snodgrass式和Duckett式(P<0.05);Ⅱ期手术中,采用膀胱粘膜修补的成功率也明显高于Snodgrass和Duckett术式(P<0.05);<14岁的患儿采用Duckett术式的成功率明显高于≥14岁的患者(P<0.05)。结论:在3种术式中,游离膀胱黏膜成形术更适合于后段尿道下裂患者,<14岁的患儿推荐采用Duckett术式。

Snodgrass Technique,Duckett Repair and Bladder Mucosa Grafting for Hypospadias:An Analysis of 251 Cases

Objective:To present the experience in using the Snodgrass technique,Duekett repair and bladder mucoaa grafting for hy-pospadias. Methods:We retrospectively reviewed 251 cases of middle and posterior hypospadias treated by the Snodgrass technique,Duckett repair and bladder mucosa grafting from February 1997 to December 2008. Results:The Success rates of the Snodgrass tech-nique,Duckett repair and bladder mucosa grafting were 80.3%(53/66),76%(19/25)and 78.9%(15/19)for middle hypospadi-as and 68.3%(41/60),63.6%(14/22)and 88.1%(52/59)for the posterior type without statistical significant differences(all P >0.05).Bladder mucosa grafting showed a significantly higher success rate than the other two procedures in either one-stage or two-stage surgical repair of posterior hypospadias(P<0.05).Duckett repair achieved a significantly higher rate of success in children under 14 years than in the older ones(P<0.05). Conclusion:Of the three sargical options,bladder milcosa grafting is the most suitable for posterior hypnspadias,and Duckett repair is recommended for children under 14 years of age.