摘要目的 观察人绒毛膜促性腺激素(HCG)治疗尿道下裂并小阴茎的临床疗效及安全性.方法 将48例尿道下裂并小阴茎的患儿简单随机法随机分为HCG治疗组(试验组)和非治疗组(对照组),各24例.观察试验组患儿用药后阴茎长度和阴茎头直径的变化,同时检测患儿用药前后骨龄、睾酮(T)及第二性征等的改变.对2组患儿均采用Duckett尿道成形术,术后密切随访,记录可能出现的并发症,如尿瘘、尿道狭窄、尿道憩室及尿道崩裂.结果 1.试验组患儿治疗后阴茎长度增长(1.08±0.47) cm,治疗前后比较差异有统计学意义(t=-5.196,P<0.05);治疗后阴茎头直径增长(0.31±0.06) cm,治疗前后比较差异有统计学意义(t=-5.080,P<0.05).2.试验组2例发生尿瘘,对照组8例发生尿瘘,2组比较差异有统计学意义(χ2=4.547,P<0.05).试验组中3例需再次手术,对照组中9例需再次手术,2组比较差异有统计学意义(χ2=4.000,P<0.05).试验组尿道下裂并小阴茎患儿术中阴茎解剖清晰,层次分明,更易于分离,岛状皮瓣血供更加丰富.结论 短期HCG治疗能够有效促进尿道下裂并小阴茎患儿的阴茎生长,改善阴茎解剖条件,能使患儿阴茎体周围的皮肤及皮下软组织进一步发育成熟,无明显并发症,其治疗安全有效,并有助于提高手术成功率.

abstractsObjective To evaluate the curative effectiveness and safety of human chorionic gonadotropin(HCG) treatment on children with microphallic hypospadias.Methods A total of 48 consecutive children with microphalic hypospadias were enrolled in the study,and the children were randomized into the experiment group(HCG treatment) and the control group with the research randomizer.The patients in experiment group were treated with HCG prior to surgery,and the control group did not received any hormone therapy preoperatively.All children in the experiment group and the control group underwent hypospadias repair by using transverse preputial island flap (Duckett technique) urethroplasty.Penile length,diameter of glans penis,bone age,serum testosterone level,and secondary effects were recorded before and after therapy in the experiment group.Postoperative complications were assessed with respect to fistulas,urethral strictures,diverticula,meatal stenosis,and glanular dehiscence in both groups.Results (1)Mean penile length and diameter of the experiment group increased significantly by (1.08±0.47) cm (t=-5.196,P<0.05) and (0.31±0.06) cm and there was a significant difference between before and after treatment (t=-5.080,P<0.05).(2)Urethrocutaneous fistulas were observed in 8 patients in the control group compared to 2 patients in the experiment group with a statistically significant difference (χ2=4.547,P<0.05).There was a significant difference between the overall reoperation rates of control group (9 patients) and the experiment group (3 patients,χ2=4.000,P<0.05).The penile tissue of the patients in the experiment group was soft and able to be easily separated and released during the operation and the flap had more blood supply.Conclusions Pretreatment with HCG therapy prior to hypospadias repair is beneficial to children with microphallic hypospadias.Significant penile growth was seen in the children treated with HCG and there was no obvious side effect.Moreover,pretreatment with HCG is beneficial to decrease the complications and reoperation rates of hypospadias repair which proves to be effective and safe.