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挽救性马蒂厄尿道成形术:在尿道下裂修复失败中对局部组织的再利用。

Salvage Mathieu urethroplasty: reuse of local tissue in failed hypospadias repair.

作者信息

Bar-Yosef Yuval, Binyamini Joseph, Matzkin Haim, Ben-Chaim Jacob

机构信息

Department of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel.

出版信息

Urology. 2005 Jun;65(6):1212-5. doi: 10.1016/j.urology.2005.01.048.

Abstract

OBJECTIVES

To report our experience with Mathieu urethroplasty for revision of hypospadias repairs. Mathieu perimeatal-based flap urethroplasty remains a popular technique more than seven decades after its description for single-stage hypospadias repair. The excellent results of primary distal hypospadias repair are well documented, but reports of the results using the technique as a salvage procedure are sparse. The reuse of local tissue may be hampered by the presence of scar tissue and reduced vascularity.

METHODS

A total of 40 patients underwent salvage urethral reconstruction. Of the 40 patients, 34 (mean age 70 months, range 11 to 216) underwent salvage Mathieu urethroplasty. All patients underwent surgery at least 6 months after the previous surgery. One, two, and three or more prior procedures had been performed in 22, 6, and 6 patients, respectively. The mean follow-up period was 29 months (range 1 to 84). In 6 patients, local tissue was scarred and immobile, and they underwent the procedure using buccal mucosal grafts.

RESULTS

Satisfactory functional and cosmetic results after the initial procedure were achieved in 25 patients (74%). Two patients underwent reoperation for repair of meatal stenosis, and 5 (15%) underwent simple repair of fistula without the need for urethral reconstruction. Two patients underwent reoperation at other medical centers and were lost to follow-up. Overall, cure was achieved in 32 (94%) of the 34 patients.

CONCLUSIONS

Mathieu urethroplasty is an efficient technique for salvage hypospadias repair. Patient selection is the key to successful repair. Despite the effects of previous surgery, local tissue of adequate quality to facilitate repair exists in most patients.

摘要

目的

报告我们采用马蒂厄尿道成形术修复尿道下裂的经验。基于尿道口周围皮瓣的马蒂厄尿道成形术自被描述用于一期尿道下裂修复以来,七十多年间一直是一种常用技术。原发性远端尿道下裂修复的出色效果已有充分记录,但将该技术用作补救手术的结果报告却很少。局部组织存在瘢痕组织和血运减少可能会妨碍局部组织的再利用。

方法

共有40例患者接受了补救性尿道重建。在这40例患者中,34例(平均年龄70个月,范围11至216个月)接受了补救性马蒂厄尿道成形术。所有患者均在上次手术后至少6个月接受手术。分别有22例、6例和6例患者之前接受过一次、两次及三次或更多次手术。平均随访期为29个月(范围1至84个月)。6例患者的局部组织瘢痕化且活动度差,他们采用颊黏膜移植进行了该手术。

结果

25例患者(74%)在初次手术后获得了满意的功能和外观效果。2例患者因尿道口狭窄修复而再次手术,5例(15%)患者仅进行了瘘管简单修复,无需尿道重建。2例患者在其他医疗中心再次手术,随后失访。总体而言,34例患者中有32例(94%)治愈。

结论

马蒂厄尿道成形术是修复尿道下裂的一种有效技术。患者选择是成功修复的关键。尽管有先前手术的影响,但大多数患者仍存在质量足以便于修复的局部组织。

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