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目的探讨筋膜瓣技术在尿道下裂术中应用于创面修复的方法及可行性。方法收集先天性尿道下裂中需行尿道重建的患儿603例,年龄2～18岁。486例为首次手术病例,117例为再次手术病例。按尿道下裂病变特点分别采用Mathieu、带蒂岛状皮瓣法、Snodgrass、Duckett、Duckett+Duplay、Duplay、Thiersch术及膀胱黏膜法等重建尿道。按治疗年限及尿道创面覆盖方法分为筋膜瓣组360例(分别应用尿道自身筋膜瓣、阴茎旋转筋膜瓣、阴茎去上皮筋膜瓣、阴囊轴形筋膜瓣及任意筋膜瓣覆盖新建尿道,再行皮瓣转移错位缝合覆盖阴茎创面)和皮瓣组243例(直接应用皮瓣转移覆盖阴茎创面)。患儿均采用相同缝线及尿道支架材料。术后抗炎,10～14 d拔管。结果各种尿道重建术式中筋膜瓣组尿瘘的发生率均低于皮瓣组。除Duplay及膀胱黏膜法两术式外,其余术式2组尿瘘率比较差异均有统计学意义(Pa<0.05)。筋膜瓣组37例发生尿瘘,无尿道全程裂开等严重并发症病例,总尿瘘率为10.3%;皮瓣组77例发生尿瘘,其中17例新建尿道全程裂开,总尿瘘率为31.7%,2组总尿瘘率比较差异有统计学意义(P=0.000)。结论筋膜瓣技术适用性广、取材灵活,可为尿道提供良好的组织覆盖,有效避免尿瘘的发生,可作为尿道下裂术中创面修复的常规方法。
Objective To investigate the method and feasibility of applying fascia flap technique in wound repair in hypospadias. Methods Sixty-three children with urethral reconstruction undergoing congenital hypospadias were collected, aged 2-18 years. 486 cases were the first operation cases and 117 cases were reoperation cases. According to the characteristics of hypospadias lesions were used Mathieu, pedicle island flap method, Snodgrass, Duckett, Duckett + Duplay, Duplay, Thiersch method and bladder mucosa reconstruction of the urethra. According to the treatment and urethral wound coverage method is divided into fascia flap group of 360 cases (respectively, urethral fascia flap, penile rotation fascia flap, penis to the epithelial fascia flap, scrotal axial fascia flap and any fascia flap coverage New urethra, and then the flap transfer misplaced suture covered penis wounds) and flap group of 243 cases (direct application of flap covering the penis wound). Children with the same suture and urethral stent material. Postoperative anti-inflammatory, 10 ~ 14 d extubation. Results The incidence of urinary fistula in fascia flap group was lower than that of flap group in various urethral reconstruction procedures. In addition to Duplay and bladder mucosa two surgery, the remaining surgery group 2 urinary fistula rate differences were statistically significant (Pa <0.05). Fistula flap group of 37 cases of urinary fistula, no cases of urethral dehiscence and other serious complications, the total urinary fistula rate was 10.3%; skin flap group of 77 cases of urinary fistula, of which 17 cases of urethra split open, the total urinary fistula rate was 31.7% The total urinary fistula rate in the two groups was significantly different (P = 0.000). Conclusion The technique of fascia flap has wide applicability and flexible drawing. It can provide good tissue coverage for the urethra and effectively prevent the occurrence of urinary fistula. It can be used as a routine method for wound repair in hypospadias.