外科皮瓣修复先天性尿道下裂的临床观察

目的：探讨采用不同外科皮瓣修复先天性尿道下裂的临床疗效。方法：回顾性分析我院133例先天性尿道下裂患者采用不同外科皮瓣治疗的病例资料。结果：不同类型尿道下裂修复应用不同外科皮瓣：Ⅰ、Ⅱ、Ⅲ型尿道下裂修复主要应用阴茎阴囊皮瓣＋尿道板、尿道板，Ⅳ型尿道下裂修复主要应用阴茎阴囊皮瓣、阴茎阴囊皮瓣＋尿道板；阴茎阴囊皮瓣＋尿道板对Ⅰ、Ⅱ、Ⅲ型尿道下裂治愈率无明显差异（P〉0．05），尿道板对Ⅲ型尿道下裂的治愈率低于Ⅰ型和Ⅱ型尿道下裂（P〈0．05）；阴茎阴囊皮瓣＋尿道板、尿道板分别对Ⅰ型和Ⅱ型尿道下裂治愈率相似（P〉0．05），但阴茎阴囊皮瓣＋尿道板对Ⅲ型尿道下裂治愈率显著高于尿道板（P〈0．05）。阴茎阴囊皮瓣＋尿道板、尿道板治疗尿道下裂术后尿瘘发生率分别为23．0％和42．9％，阴茎阴囊皮瓣无并发症发生。结论：手术治疗不同类型尿道下裂应选择适宜的外科皮瓣；阴茎阴囊皮瓣＋尿道板较适用于各型尿道下裂的修复治疗，单独尿道板较适用于Ⅰ型和Ⅱ型尿道下裂的修复治疗。

Assessment of Clinical Efficacy of Surgical Flaps for Hypospadias

Objective： To investigate the clinical efficacy of various surgical flaps for congenital hypospadias. Methods： 133 cases of hypospadias treated with different surgical flaps in our hospital were reviewed. Results： Different types of hypospadias underwent different surgical flaps urethroplasty. Urethral plate and Combination of penoscrotal flap and urethral plate were mostly for type Ⅰ, Ⅱ and Ⅲ hypospadias, while penoscrotal flap, preputial flap and combination ofpenoscrotal flap and urethral plate for type Ⅳ. There was no significant difference among the success rate of combination of penoscrotal flap and urethral plate for type Ⅰ, Ⅱ and Ⅲ hypospadias, while the success rate of urethral plate for typeⅢwas lower than for type Ⅰ and Ⅱ .The success rate of combination of penoscrotal flap and urethral plate for type Ⅰ and Ⅱ was similar to urethral plate, but for type Ⅲ the former was higher than the latter. The fistula rate of combination of penoscrotal flap and urethral plate was 23.0%, urethral plate 42.9% and there was significant difference （p〈0.05）. Conclusion： Different surgical flaps should be chosen for different types of hypospadias. Combination of penoscrotal flap and urethral plate is adopted for various types of hypospadias, while urethral plate is adopted for type Ⅰ and Ⅱ hypospadias.