Duckett术式治疗儿童尿道下裂疗效及并发症防治

Duckett procedure for children suffered from hypospadias: Outcomes and complications

  • 摘要: 目的 探讨Duckett术式治疗儿童尿道下裂的疗效及其并发症的防治。 方法 对2009年4月- 2017年5月就诊于我院小儿外科的23例复杂尿道下裂儿童行Duckett尿道成形术治疗,分析此术式治疗儿童尿道下裂的适应证及其并发症的防治。 结果 23例接受Duckett术式治疗的尿道下裂患儿,年龄1 ~ 11岁,平均3.85岁;其中20例为初次手术,3例为再手术;均存在明显的阴茎下屈畸形或会阴部畸形。严重的阴茎下屈畸形合并阴茎阴囊转位15例(65.22%),阴茎下屈畸形复发、尿道瘘、尿道憩室、尿道结石及感染等难治性尿道下裂1例,合并尿道重复畸形1例,合并两性畸形1例。阴茎下屈畸形完全纠正后,海绵体尿道外口均移向近端,阴茎体近端型3例(13.04%),余20例属于阴茎阴囊型、阴囊型、会阴型等复杂近端型尿道下裂(86.96%);其中会阴型尿道下裂9例,4例行Duckett+Duplay术式,5例行Duckett术式。一期手术及修瘘术后成功治愈20例(86.96%)。 结论 Duckett尿道成形术或Duckett+Duplay尿道成形术适用于儿童复杂近端型尿道下裂及合并其他畸形;阴茎下屈畸形未完全纠正、海绵体创面活动性渗血、Duckett皮瓣血运不良缺乏弹性及Duplay U型皮瓣裁剪过窄是术中应该注意的问题。

     

    Abstract: Objective To analyze indication of Duckett procedure for children suffered from hypospadias and management of its complications. Methods From June 2009 to May 2017, 23 children who suffered from complex hypospadias admitted to department of pediatric surgery underwent Duckett procedure to reconstruct their urethra. The indication of this procedure and the management of its complications were analyzed. Results Of the 23 patients receiving Duckett procedure, their age ranged from 1 to 11 years with an average of 3.85 years old. Twenty cases underwent primary urethral reconstruction, and 3 cases underwent secondary reconstruction. All patients presented with chordee or significant perineal malformation. Fifteen cases presented with severe chordee or penoscrotal transposition with a percentage of 65.22, one patient with refractory hypospadias presented with recurrent chordee, fistula, divertculum, stones and infection, one patient suffered from urethral duplication accompanied with hypospadias, one patient was characterized with intersex and hypospadias. Spongiosum urethral moved backwardly with the correction of chordee. New meatus located at proximal penile in 3 patients with a percentage of 13.04, while meatal sites moved backwardly to penoscrotal junction, intra-scotum and perineal respectively for the other 20 cases with a percentage of 86.96. Nine patients were classified as perineal hypospadias, four of them

     

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