李君贵+姜山+黄雨峰+高兴林+刘东军

[摘要] 目的 比较皮下隧道与皮肤切开膀胱黏膜移植二期尿道成形术治疗尿道下裂的临床效果。 方法 47例尿道下裂患者分为两组，行皮下隧道膀胱黏膜移植二期尿道成形术治疗组（A组）25例，行皮肤切开膀胱黏膜移植二期尿道成形术治疗组（B组）22例，比较两组患者术后尿道瘘及尿道狭窄的发生率。 结果 A组的尿道瘘发生率为4.00%，尿道狭窄发生率为16.00%，B组的尿道瘘发生率40.91%，尿道狭窄发生率为22.73%，两组的尿道瘘发生率比较，差异有统计学意义（P<0.005），两组的尿道狭窄发生率比较，差异无统计学意义（P>0.05）。 结论 皮下隧道膀胱黏膜移植二期尿道成形术治疗尿道下裂的临床效果优于皮肤切开膀胱黏膜移植二期尿道成形术。

[关键词] 尿道下裂；膀胱黏膜；尿道成形术；尿道瘘；尿道狭窄

[中图分类号] R695 [文献标识码] A [文章编号] 1674-4721（2014）09（b）-0024-03

Clinical effect of subcutaneous tunnel bladder mucosa graf turethroplasty in the second phase in the treatment of hypospadias

LI Jun-gui JIANG Shan HUANG Yu-feng GAO Xing-lin LIU Dong-jun

Department of Urinary Surgery，Siping Central People′s Hospital of Jilin Province，Siping 136000，China

[Abstract] Objective To compare the clinical effect of subcutaneous tunnel and skin incision bladder mucosa graf turethroplasty in the second phase in the treatment of hypospadias in the treatment of hypospadias. Methods 47 patients with hypospadias were divided into the two groups： subcutaneous tunnel bladder mucosa graf turethroplasty in the second phase treatment group （the group A，n=25） and skin incision bladder mucosa graf turethroplasty in the second phase treatment group （the group B，n=22）.The incidence rate of urethral fistula and stricture after surgery in the two groups were compared. Results The incidence rate of urethral fistula and stricture in the group A was 4.00% and 16.00% respectively，while in group B，they were 40.91% and 22.73% in turn and there was a statistical difference of the incidence rate of urethral fistula in the two groups （P<0.005），and there was no statistical difference of the incidence rate of urethral stricture （P>0.05）. Conclusion In the treatment of hypospadias，the clinical effect of subcutaneous tunnel bladder mucosa graf turethroplasty in the second phase is superior to that of skin incision bladder mucosa graf turethroplasty in the second phase.

[Key words] Hypospadias；Bladder mucosa；Urethroplasty；Urethral fistula；Urethral stricture

尿道下裂是一种男性泌尿生殖系统常见的先天畸形，发病率为0.4‰～8.2‰，主要表现为尿道口开口异位，阴茎下曲和包皮分布异常[1]。发病机制尚未完全阐明，最近的研究认为环境中广泛存在的雌激素类和抗雄激素物质的污染可能是造成尿道下裂发病率上升的原因[2]。目前唯一的治疗方法是手术治疗，临床应用的主要手术方式有Snodgrass、Duckett以及膀胱黏膜尿道成形术[3]，手术方式多达300多种，但尚无一种效果满意的术式成为金标准，其主要原因是术后并发症发生率高[4]。尿道下裂治疗的标准是：矫正阴茎下曲，成年后能正常地进行性生活；尿道口位于阴茎头正位，与正常人一样站立排尿；……