分期Duplay术治疗合并阴茎阴囊转位的重度尿道下裂

目的：探讨分期原位皮瓣卷管（Duplay）成形尿道术治疗合并阴茎阴囊转位的重度尿道下裂的临床疗效。方法2013年10月至2016年2月我们采用分期 Duplay 术式修复重度尿道下裂21例，中位年龄12（9～24）个月，其中阴囊型9例，会阴型12例，均伴有阴茎阴囊转位。Ⅰ期完成 Byars 术＋Duplay 术＋阴茎阴囊复位术，术后半年以上行Ⅱ期 Duplay 术。患儿均获得随访，中位随访时间8（6～28）个月，均观察并处理并发症，对阴茎外观进行评分。结果重建尿道中位长度5.0（4.0～6.5）cm。Ⅰ期 Duplay 成形尿道中位长度1.5（1.0～2.0）cm，术后阴囊伤口感染2例，其中1例继发根部尿道口狭窄，后行狭窄切开造口。Ⅱ期 Duplay 成形尿道中位长度3.5（3.0～4.5）cm，术后尿道瘘4例（4／21），其中根部瘘2例，体部瘘1例，冠状沟瘘1例；均已完成尿道瘘修补，术后无再次尿瘘发生；所有病例均无尿道狭窄、尿道憩室等并发症发生。Ⅱ期术后3个月对阴茎外观行改良 HOSE 评分，为17～20分，平均19分。结论分期 Duplay 术治疗合并阴茎阴囊转位的重度尿道下裂安全有效，并发症相对较少，也得到令医患满意的外观。

Efficacies of staged Duplay repairing for severe hypospadias with penile-scrotal transposition

Objetive To explore the efficacies of staged Duplay operation for severe hypospadias with penile-scrotal transposition. Methods A total of 21 patients with severe hypospadias underwent staged Duplay repairing.All of them had associated penile -scrotal transposition.The median age was 1 2 (9 ~24)months.The clinical types were scrotal (n =9)and perineal (n =1 2).The Byars and Duplay operations with penile -scrotal restoration were performed in stageⅠ.And stageⅡDuplay operation was performed at 6 months after stageⅠrepair.The median follow -up period was 8 (6 -28)months.The postoperative complications were managed accordingly and the appearances were scored. Results The median length of new urethra was 5.0 (4.0 ~6.5)cm.And it was 1 .5 (1 .0 ~2.0)cm during stageⅠDuplay operation and 3.5 (3.0 ~4.5)cm during stageⅡDuplay operation.Two cases of scrotal infection occurred after stageⅠ.Urethral meatus stenosis appeared at the base of penis in one case and urethrostenotomy was performed afterwards.Four cases of urethral fistula appeared after stageⅡ.The locations were at the base of penis (n =2),body (n =1 )and corona (n =1 ).Four fistulas were cured by repairing.Such complications as urethral stricture and urethral diverticulum were not found.The mean modified HOSE score of appearance was 1 9 (1 7 ~20)at 3 months after stageⅡ.Conclusions Staged Duplay repairing is recommended for severe hypospadias with penile-scrotal transposition because of high safety,low complication rate and satisfactory cosmetics.