Paulus C, Dessouki T, Chehade M, Takvorian P, Dodat H
Service de Chirurgie Pédiatrique, Hôpital Edouard-Herriot, Lyon, France.
Eur J Pediatr Surg. 1993 Apr;3(2):87-91. doi: 10.1055/s-2008-1063518.
220 distal hypospadias have been operated over a period of 10 years: 53 glandular, 144 coronal and 23 anterior penile subcoronal hypospadias with no chordee. Although with 131 MAGPI procedures we had only 3 urethral complications (one fistula, one total and one partial disunion), it does not seem to be a well adapted procedure for the correction of coronal and anterior penile hypospadias: the new meatus is not exactly apical, the glans remains short on its inferior side, and we often noticed a distal curvature at the end of the intervention. The urethroplasty technique that we performed 89 times avoids these disadvantages: the urethra is reconstructed in 2 layers as far as the summit of the glans according to Duplay's procedure, the urethrocutaneous adhesions are freed down the penis, the distal thin urethra is covered by an intermediate layer and the shortage of ventral skin is compensated for by the formation of a circular esthetic mucous annulus. There have been no complications with glandular hypospadias (7 cases), 4 with coronal hypospadias (64 cases) and 4 with anterior penile hypospadias (18 cases). While the MAGPI procedure remains an excellent technique for the correction of glandular hypospadias, the Duplay's procedure is better adapted for the correction of coronal hypospadias, in spite of the occurrence of more frequent (easily treated) fistula (6.25%). The juxta coronal position of some anterior penile hypospadias is still better repaired by the Mathieu's or the Snyder's procedures.
在10年的时间里，共对220例远端尿道下裂患者进行了手术：53例为龟头型，144例为冠状沟型，23例为阴茎头冠状沟前型，均无阴茎下弯。尽管采用131例MAGPI手术仅出现3例尿道并发症（1例瘘管、1例完全分离和1例部分分离），但该手术似乎并不适合矫正冠状沟型和阴茎头冠状沟前型尿道下裂：新尿道口并非恰好位于顶端，龟头下侧仍较短，而且我们常在手术结束时注意到远端弯曲。我们实施了89次的尿道成形术技术避免了这些缺点：根据杜普雷手术方法，尿道分两层重建直至龟头顶端，阴茎下行尿道皮肤粘连松解，远端细尿道由中间层覆盖，通过形成环形美观黏膜环来弥补腹侧皮肤短缺。龟头型尿道下裂（7例）无并发症，冠状沟型尿道下裂（64例）有4例并发症，阴茎头冠状沟前型尿道下裂（18例）有4例并发症。虽然MAGPI手术仍然是矫正龟头型尿道下裂的优秀技术，但尽管瘘管发生率更高（易于治疗）达6.25%，杜普雷手术更适合矫正冠状沟型尿道下裂。部分阴茎头冠状沟前型尿道下裂的近冠状沟位置仍通过马蒂厄或斯奈德手术修复效果更佳。
