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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。
Objective To investigate the curative effect and prevention and treatment of Duckett’s surgical treatment of hypospadias in children. Methods Duckett urethroplasty was performed in 23 children with complicated hypospadias who were treated in pediatric surgery in our hospital from April 2009 to May 2017. The indications for the treatment of hypospadias in children and the prevention and treatment of the complications were analyzed . Results Twenty-three children with hypospadias treated with Duckett’s surgery, aged 1 to 11 years (average 3.85 years), of whom 20 were undergone primary surgery and 3 underwent reoperation. All had significant penile deformities or perineal deformities . 15 cases (65.22%) had penile scrotal transposition, penile deformity recurrence, urethral fistula, urethral diverticulum, urethral calculus and infection, one case had refractory hypospadias, one case had urethral deformity , Merger genital malformation in 1 case. After the correction of penile deformity, the outer urethra of the sponge moved to the proximal end, and the proximal penis type was 3 cases (13.04%). The other 20 cases were complicated proximal urethra such as penis scrotum, scrotum and perineal (86.96%); of which 9 cases of perineal hypospadias, Duckett + Duplay operation in 4 cases and Duckett operation in 5 cases. Twenty cases (86.96%) were successfully cured after operation and fistula. Conclusions Duckett urethroplasty or Duckett + Dupla urethroplasty is suitable for complicated proximal hypospadias and other deformities in children. The penile deformity is not corrected completely, the spontaneous wound bleeding in active sponge and the lack of Duckett flaps Elastic and Duplay U-shaped skin flap narrowing is an intraoperative should pay attention to the problem.