尿道板纵切卷管法和加盖岛状皮瓣法尿道成形术治疗尿道下裂的比较

目的总结尿道板纵切卷管法（TIP）与加盖岛状皮瓣法（OIF）尿道成形术治疗尿道下裂的疗效，并对其进行比较，探讨术式选择的条件。方法回顾性总结42例TIP术和26例OIF术治疗尿道下裂的临床资料。TIP术组年龄2～13岁，平均4．76岁；其中Ⅱ型3例，Ⅳ型1例。38例为初次行尿道成形术者，4例为初次尿道成形术失败、再次行尿道成形术者。OIF术组年龄2～10岁，平均4．72岁，其中Ⅱ型23例，Ⅲ型3例，均为初次行尿道成形术者。结果TIP术平均手术时间80min，有尿瘘7例，阴茎头裂开1例，无尿道狭窄，但有尿道外口狭窄1例，3例再次尿道成形术者未发生并发症；OIF术平均手术时间115min，有尿瘘5例，阴茎头裂开l例，无尿道狭窄。两种手术方法的尿瘘、尿道狭窄、阴茎头裂开、一次手术成功率，差异无统计学意义（P〉0．05），而两组平均手术时间的差异有统计学意义（P〈0．05）。结论TIP与OIF尿道成形术可用于阴茎头冠状沟、阴茎体、阴茎阴囊型尿道下裂的治疗，TIP术操作简单，且更适用于初次手术失败、需再次行尿道成形术的病例。对于阴茎发育差，尿道板条件不好的初次手术病例，仍以选择OIF术为宜。

Comparison of tubularized incised plate and onlay island flap urethroplasty in the treatment of hypospadias

Objective To evaluate and compare the efficacy of the tubularized incised plate （TIP） urethroplasty and the onlay island flap （OIF） urethroplasty in hypospadias repair. Methods The clinical data of 42 cases of TIP procedures and 26 cases of OIF procedures were analyzed retrospectively. Patients in the TIP group were 2-13 years old,with an average age of 4.76, including 3 cases of Ⅱ type, and 1 case of Ⅳ type. Of them, 38 cases received primary surgery, and 4 repeated surgery. Patients in the OIF group were 2-10 years old, with an average age of 4.72, including 23 cases of Ⅱ type, and 3 cases of Ⅲ type, all receiving primary surgery. Results In the TIP group, the mean duration of surgery was 80 min, 7 cases developed urethral fistula, 1 case neourethral dehiscence, and 1 case meatus urinarius stricture. 3 cases receiving repeated surgery developed no complications. In the OIF group, the mean duration of surgery was 115 min. 5 cases developed urethral fistula, 1 case neourethral dehiscence, and none developed urethral stricture. There was no statistically significant difference in the incidence of fistula, stricture, dehiscence and success rate of one-stage operation between the TIP group and the OIF group （P〉0.05）, but there was statistically significant difference in the mean duration of surgery between these two groups （P〈0.05）. Conclusion TIP and OIF urethroplasty can be used for distal and proximal hypospadias. TIP urethroplasty is more simple than OIF urethroplasty, and more applicable to the cases failed in primary surgery; OIF urethroplasty is suitable for the primary surgery patients with poor development of penis and urethral plate.