摘要
目的探讨尿道下裂患儿中阴茎下曲的分类诊断及其针对性治疗的重要性与意义。方法对中山大学附属第一医院1989—2011年诊治的尿道下裂合并阴茎下曲的患儿进行随机抽样回顾与对照研究。患儿分两组：A组为传统组（232例），术前仅依据临床症状或人工刺激诱发勃起诊断阴茎下曲，术中经验性地进行下曲纠正，未进行客观评估，下曲纠正方法包括阴茎脱套、浅深筋膜松解、尿道板离断等；B组为研究组（25例），术前依据临床症状和人工刺激诱发勃起诊断阴茎下曲外，均严格实行术中阴茎海绵体盐水注射人工勃起试验对阴茎下曲进行分类诊断、针对性治疗以及矫正效果评估。根据病因病理不同，将阴茎下曲分为皮肤型、筋膜型、尿道型、海绵体型及阴茎头型。下曲纠正方法除了针对性选用A组的术式外，接受不同方式白膜折叠术者占24％（6／25）。结果A组术后阴茎下曲持续或复发者86例（37％），痛性勃起者25例（11％），患者或家属对下曲改善满意与基本满意者183例（79％），随访时年龄≥18岁者25例，IIEF-5评分〈21分者7例（28％）。B组阴茎下曲单一类型者7例（28％），合并类型者18例（72％），术后随访无下曲持续与复发，无痛性勃起，患者或家属对下曲改善满意度为100％。两组阴茎下曲疗效差异有统计学意义（P〈0．05）。B组中折叠组（6例）矫正前后阴茎勃起时长度分别为（4．58±1．59）、（6．16±2．54）cm；非折叠组（19例）分别为（4．01±1．18）、（5．82±1．51）cm，两组术后阴茎勃起长度均较术前明显增加（P〈0．05），但组间比较差异无统计学意义（P〉0．05）。结论应重视尿道下裂患儿阴茎下曲的分类病因病理诊断，针对性地选用下曲纠正治疗方式能进一步提高尿道下裂治疗效果。尿道下裂中阴茎下曲的病因病理改变可单一也可合并存在。阴茎下曲纠正术能增长阴茎长度，与其他阴茎下曲矫正术相比，阴茎背侧白膜折叠术对阴茎长度的影响无明显差异。
Objective To explore the importance and significance of classification diagnosis and treatment of chordee among hypospadias in children. Methods A random sample review and controlled study was made in patients with hypospadias and ehordee from 1989 to 2011 in First Affiliated Hospital of Sun Yat-Sen University, and the patients were divided into 2 groups. There were 232 cases in group A, who were all diagnosed as chordee only on the basis of clinical symptoms or an erection induced by artificial stim- ulation before operation. All the 232 cases were corrected empirically without objective assessment by degloving the penis, dissecting superficial and deep fascia, and cutting off the urethral plate, and so on during operation. There were 25 cases in group B, who were all strictly implemented on classification diagnosis and treatment of chordee, in sponge saline injection test during operation and correction effect evaluation after operation. Chordee was classified according to different etiology and pathology： skin type, fascia-type, urethra type, sponge type and the glans of penis type. There were different operating methods in different ways of folding tuniea albuginea. Results In group A, 86 patients （37%） had postoperative recurrence of chordee, 25 patients （11% ） had pain during erection after surgery, 183 patients were satisfied with correction of chordee （79%）. In group A, 25 patients were in their adulthood when followed up, and 7 patients had IIEF-5 score 〈21 points. In group B, the single type of chordee among hypospadias were 7/25 （28%） , merged type were 15/25 （72%）. All patients were followed up without chordee recurrence or painless erection, and 100% patients or families were satisfied with correction of chordee. The efficacy difference were statistically significant between the two groups in chordee correction. In folding tuniea albuginea group in group B, the penile erection length was （4.58 ± 1.59） cm before the correction, and （6.16 ± 2.54） cm after correction. In non-folding tunica albuginea group, penile erection length was （4.01 ± 1.18） cm before correction, and （5.82 ± 1.51 ） cm after correction. The difference was not significant between the 2 groups in penile erection length （P 〉 0.05）. Conclusions Surgeon should pay more attention to the correction, effect evaluated, classified etiology and pathological diagnosis of hypospadias and chordee. And the targeted selection of the correct treatment of chordee can further improve the therapeutic effect. Chordee of hypospadias can exist in single or merged according to the pathological classification. Chordee correction surgery can increase length of penis, and dorsal tunica albuginea plication had no significantly different effect on the length of the penis compared to other chordee corrective surgery.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第5期386-389,共4页
Chinese Journal of Urology
关键词
尿道下裂
阴茎下曲
分类诊治
外科手术
选择性
Hypospadias
Chordee
Classification diagnosis and treatment
Surgical procedures, elective
