尿道下裂手术术式的选择及护理

目的：探讨尿道下裂手术术式的选择及护理体会。方法：选取2003年5月一2008年9月期间收治的93例确诊尿道下裂患者，对阴茎头型患者采用尿道口前移、阴茎头成形法（MAGPI术式）；尿道口在阴茎体外2／3段伴有阴茎轻度下弯者采用尿道板纵切卷管法或加盖岛状皮板法（Snodgrass术或Onlay术）；有严重阴茎下弯的所有阴茎体型采用横裁或纵裁包皮岛状皮瓣尿道成形（Duckett术）；阴囊型或会阴型用阴囊中缝皮管加横裁包皮岛状皮瓣成形尿道（Duplay联合Duckett术）；对重度尿道下裂患儿采用弧形带蒂阴茎阴囊联合皮瓣尿道成形术；对腹侧包皮外板发育良好患儿及合并阴茎下曲的患儿采用腹侧带蒂帽状包皮皮瓣法。结果：治愈82例，并发尿道瘘6例，尿道狭窄5例，治愈率为88．1％（82／93）。81例获随访，平均随访时间23．5个月（1～42个月），随访期间患儿排尿正常。结论：尿道下裂术式的选择并无统一标准，主要根据术者的经验及患者尿道及阴茎、阴囊皮瓣发育情况选择。细心周到的术后护理能降低术后并发症的发生率。

Operation mode and nursing for hypospadias

Objective:To explore operation mode and nursing for hypospadias.Methods:Selected 93 confirmed cases with hypospadias during May 2003 to Sep 2009.Patients in balanic type were treated with meatal advancement and glandularp lasty(MAGPI);patients with urethra orifice at 2/3 of corpus penis accompanied with slight chordee of penis were treated with Snodgrass method or Onlay method;patients with severe chordee of penis were treated with Duckett method;patients in scrotum or perineum type were treated with combination of Duplay and Duckett;severe hypospadia patients were treated with curved pedicle penis-scrotum and skin flap urethroplasty;patients with good outer plate of ventral prepuce and chordee of penis were treated with ventral pedicle hooded foreskin flap.Results:80 cases were in cure,6 cases were complicated with urinary fistula,and 5 cases had urethra stricture,with cure rate as 88.1%(80/93).Follow-up of 81 cases with average time as 23.5 months(1～42 months)showed normal micturition.Conclusion:There is no standard for selection of operation mode for hypospadias.Experience of surgery and status of urethra,penis and scrotum skin flap are main factors.Besides,careful nursing can also decrease the incidence of postoperative complication.