Lottmann H B, Yaqouti M, Melin Y
Service d'Urologie de l'enfant et de l'adolescent, Fondation Hôpital Saint Joseph, Paris, France.
J Urol. 1999 Sep;162(3 Pt 2):1176-80. doi: 10.1016/S0022-5347(01)68120-5.
We present our experience using the Cantwell-Ransley epispadias technique, particularly focusing on postoperative anatomical and functional complications.
Between 1989 and 1997, 40 patients 1 to 28 years old underwent the Cantwell-Ransley technique for epispadias at our institution. The condition was isolated in 17 cases and associated with exstrophy in 23. Surgery involved a primary and secondary procedure in 29 and 11 patients, respectively. Cavernocavernostomy was performed in only 16 cases.
At a mean followup of 3 years 18 patients (45%) had complications and needed further procedures, and 3 (7.5%) had major wound dehiscence. The complication rate was higher in the exstrophy than in the isolated epispadias group (65 versus 28%) and urethral complications were consistently associated with previous urethral plate sectioning. In 1 patient major and persistent loss of continence was probably related to prolonged transurethral bladder drainage. All 17 patients in the postpubertal group report erections, although 1 who did not undergo cavernocavernostomy still complains of dorsal curvature. In 36 patients (90%) a fully satisfactory anatomical and functional result was achieved.
The Cantwell-Ransley technique of epispadias repair allows successful reconstruction in most patients. However, postoperative complications, some of which are serious, may develop that are more associated with previous procedures that compromise the blood supply to the urethral plate than the Cantwell-Ransley technique.
我们介绍使用坎特韦尔-兰斯利尿道上裂修复技术的经验，尤其关注术后的解剖和功能并发症。
1989年至1997年间，我们机构对40例年龄在1至28岁的患者采用坎特韦尔-兰斯利技术治疗尿道上裂。其中17例为单纯性尿道上裂，23例合并膀胱外翻。手术中，29例患者接受了一期手术，11例患者接受了二期手术。仅16例患者进行了海绵体-海绵体吻合术。
平均随访3年时，18例患者（45%）出现并发症并需要进一步治疗，3例（7.5%）出现严重伤口裂开。膀胱外翻组的并发症发生率高于单纯尿道上裂组（65%对28%），尿道并发症始终与先前的尿道板切开有关。1例患者出现严重且持续的尿失禁，可能与长期经尿道膀胱引流有关。青春期后组的所有17例患者均有勃起，尽管1例未进行海绵体-海绵体吻合术的患者仍抱怨阴茎背曲。36例患者（90%）获得了完全满意的解剖和功能结果。
坎特韦尔-兰斯利尿道上裂修复技术可使大多数患者成功重建。然而，术后可能会出现一些严重的并发症，这些并发症更多地与先前影响尿道板血供的手术有关，而非坎特韦尔-兰斯利技术本身。
