摘要目的 比较Duckett联合Duplay术和Koyanagi术一期修复重型尿道下裂的临床疗效,探讨两种术式的优缺点.方法 回顾性总结分析2001年10月至2012年6月采用上述方法治疗205例重型尿道下裂的临床资料.其中,行Duckett联合Duplay术108例,Koyanagi术97例.结果 Duckett联合Duplay术组:会阴型尿道下裂32例,阴囊型尿道下裂76例,术后发生尿瘘11例(10.1％),吻合口狭窄6例(5.6％),尿道口狭窄伴憩室形成3例(2.8％),重建尿道长度3.5～10 cm,平均5.8 cm; Koyanagi术组:会阴型尿道下裂51例,阴囊型尿道下裂46例,术后发生尿瘘12例(12.4％),龟头及阴茎前段尿道裂开4例(4.1％),没有尿道狭窄发生,重建尿道长度3～7 cm,平均5.2cm.所有病例均获得了3个月以上随访,阴茎外观、尿道功能满意、阴囊对裂纠正,两组病例术后总并发症发生率(18.5％和16.5％)行x2检验比较,差异无统计学意义(P＞0.05).结论 Duckett联合Duplay术和Koyanagi术都是一期修复重型尿道下裂的常用术式,具有满意的治疗效果,前者以尿瘘和尿道狭窄为主要并发症,更适用于包皮发育较好、阴茎弯曲不十分严重的病例,后者以尿瘘及远侧尿道裂开为主要并发症,更适用于包皮发育较差,阴茎严重弯曲伴有阴茎阴囊转位的病例,能有效减少尿道狭窄的发生.

abstractsObjective To Compare the clinical efficacy of Duckett combining with Duplay technique and Koyanagi technique for severe hypospadias in one-staged repair and to investigate the advantages and disadvantages of each technique.Methods Clinical data of 205 patients who underwent either procedure between October 2001 and June 2012 were reviewed retrospectively.Of the 205 patients,108 underwent Duckett combining with Duplay technique repair,whereas 97 were treated by Koyanagi technique.Results In the Duckett combining with Duplay technique group,there were 32 patients with perineal hypospadias and 76 with scrotal hypospadias.Fistula was noted in 11 patients (10.1％) postoperatively.Anastomotic stricture occurred in 6 cases (5.6％) and meatal stricture associated with the formation of diverticulum occurred in 3 cases (2.8％).The length of reconstructed urethral was 3.5 to 10 cm,with 5.8 cm of average.In Koyanagi technique group,there were 51 patients with perineal hypospadias and 46 with scrotal hypospadias.Twelve (12.4％) patients had postoperative fistula.Split of glans and urethra in penile forepart developed in 4 cases (4.1％).The length of reconstructed urethral was 3.0 to 7.0 cm,with 5.2 cm on average.Follow-up period was more than 3 months.Penile appearance and urethral function were satisfactory.Scrotum bifida was corrected.The incidence of total postoperative complications was not significantly difference (P＞0.05).Conclusions Both Duckett combining with Duplay technique and Koyanagi technique are common methods in one-staged repair for severe hypospadias with satisfactory therapeutic effects.The former technique is more suitable for patients with well-developed foreskin and mild penile curvature.The main post-operative complications are fistula and meatal stricture.Koyanagi technique is more suitable for patients with poorly developed foreskin and severe penile curvature,accompanied by penoscrotal transposition.It could be more effective to decrease the incidence of meatal stricture.The main postoperative complications of Koyanagi technique are fistula and distal urethral dehiscence.